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so  In  This  Issue: 

ow  to  compete  under  managed  competition Leigh  Truitt , MD,  President , CMS 

pdate  on  Health  Care  Reform Bill  Pierson , Managing  Editor 

lections/Legislative  Reports Alan  Rapp , Chairman , Council  on  Legislation 


Doctor,  Doctor! 
Come  Quick! 
There’s  a Process  Server 


in  the  Waiting  Room! 


An  unlikely  scenario?  Unfortunately,  no.  Colorado 
physicians  are  on  the  receiving  end  of  malpractice 
suits  on  the  average  of  once  every  seven  years. 

$ The  right  response?  Accept  the  summons 
or  subpoena,  then  pick  up  your  phone  and 
call  Copic  Insurance  Company  Headquarters, 
which  is  right  here  in  Colorado.  The  damage 
control  will  start  immediately,  and  you’ll 
feel  better  in  the  morning.  ❖ But,  you  say, 
what  if  the  targeted  physician  is  one  of  the 
minority  in  Colorado  who  didn’t  choose  Copic? 

♦♦♦  Well,  maybe  he  or  she  won’t  feel  better  in  the  morning. 

The  Copic  Bottom  Line.  It’s  more  than  just  competitive  rates. 


Copic  Insurance  Company 

EO.  Box  17540  • Denver,  CO  80217-0540  * (303)  779-0044  • 1-800-421-1834 


Colorado  Medicine 

January,  1993  Volume  90,  Number  1 


Cover  Story 


It's  anybody's  guess  what 
1993  will  hold  for  health 
care  professionals,  but  a look 
back  may  help.  Check  out 
Ruminations  on  page  38. 


On  This 

7 How  to  compete  under  managed  competition 

Leigh  Truitt , MD 
President,  1992-1993 


10  Update:  Health  Care  Reform 


Bill  Pierson 
Managing  Editor 


1 1 1992  Election  success 


COMP  AC 


20  The  Interview  (Part  3 of  3) 


Joe  Batuello,  MSI 


Departments 

7 President's  Letter 
9 Copic  Comment 
1 2 The  Lobby 
1 5 Letters 

16  Health  Care  Financing 
18  Committee  Update 
21  Board  Highlights 
24  Medical  News 
26  New  Members 

31  In  Memory 

32  New  Officers 

36  Classified  Advertising 
38  Ruminations 


22  Introducing  your  Board  of  Directors 


Colorado  Medical  Society 


COLORADO  MEDICAL  SOCIETY 
OFFICERS,  BOARD  MEMBERS  and  AMA  DELEGATES 


1992/1993  Officers 
Leigh  Truitt,  M.D. 

President 

Wm.  Carl  Bailey,  MD 

President-elect 
Terrance  J.  Sullivan,  M.D. 

Treasurer 

Stuart  O.  Silverberg,  M.D. 

Speaker  of  the  House 

David  C.  Martz,  M.D. 

Vice-speaker  of  the  House 

Sandra  L.  Maloney 

Secretary/Executive  Director 

Harrison  G.  Butler,  Ml,  M.D. 

(Immediate  Past  President) 


Board  of  Directors 

Board  of  Directors 

Thomas  J.  Allen,  MD 

Dieter  W.  Schneider,  MD 

Stephen  G.  Batuello,  MD 

David  Shander,  MD 

John  O.  Cletcher,  Jr.,  MD 

W.  George  Shanks,  MD 

Donald  G.  Eckhoff,  MD 

Susan  A.  Shermas,  MD 

John  E.  Elliff,  MD 

Gary  D.  VanderArk,  MD 

Jonathan  C.  Feeney,  MD 

Denis  J.  Winder,  MD 

David  C.  S.  Franklin,  MD 
Joel  M.  Karlin,  MD 

M.  Robert  Yakely,  MD 

George  M.  Kreye,  MD 
Muryl  L.  Laman,  MD 

AMA  Delegates 

Ted  T.  Lewis,  MD 

M.  Ray  Painter,  Jr.,  MD 

Maura  J.  Lofaro,  MS  IV 

Richert  E.  Quinn,  Jr.,  MD 

Louise  L.  McDonald,  MD 
Robert  R.  Montgomery, 

Mark  A.  Levine,  MD 

Legal  Counsel 
Robert  A.  Nathan,  MD 

Alternate  Delegates 

Kenneth  M.  Olds,  MD 

Robert  D.  McCartney,  MD 

Lothar  K.  Roller,  MD 

Robert  M.  Bogin,  MD 
Joel  M.  Karlin,  MD 

COLORADO  MEDICAL  SOCIETY  STAFF 


Executive  Office 

Sandra  L.  Maloney,  Executive  Director 
Mary  Lee  Johnston,  Executive  Admin.  Asst. 
Nancy  L.  Deter,  Manager,  Accounting 

Western  Slope  Office 

Dolores  M.  Bennett,  Executive  Secretary 

Division  of  Membership  Information  Services 

Timothy  H.  Roberts,  Director 
Diane  L.  LeHew,  Manager,  Support  Services 
Debra  M.  Jones,  Membership  Coordinator 
Beth  M.  Crusha,  Administrative  Assistant 

Division  of  Professional  Services 

Sandra  M.  Finney,  Director 
Lorraine  H.  Heth,  Program  Manager 
Kirsten  E.  Regalado,  Secretary 


Division  of  Health  Care  Policy 

Ellen  J.  Stein,  Director 

Marilyn  P.  Barton,  Program  Manager 

Lynn  R.  Livingston,  Administrative  Assistant 

Division  of  Health  Care  Financing 

Edie  K.  Register,  Director 

Marijo  M.  Parkin,  Program  Manager 

Division  of  Government  Relations 

Sue  Ellen  Quam,  Director 

Lorraine  L.  Koehn,  Program  Manager/Lobbyist 

K.  Suzanne  Hamilton,  Administrative  Assistant 

Division  of  Communications 

William  S.  Pierson,  Director 

Michael  P.  Thompson,  Communications  Spec. 

Gil  Maestas  II,  Communications  Staff 


COLORADO  MEDICINE  (ISSN-01 99-7343)  is  published  monthly  as  the  official  journal  of  the  Colorado  Medical  Society,  7800  E.  Dorado  PI.,  Englewood,  CO  801 1 1 . Telephone  (303)  779-5455.  Outside 
Denver  area,  call  1 -800-654-5653.  Second  Class  postage  paid  at  Englewood,  Colorado,  and  at  additional  mailing  offices.  POSTMASTER,  send  address  changes  to  COLORADO  MEDICINE,  P.  O.  BOX 
1 7550,  Denver,  CO  80217-0550.  Address  all  correspondence  relating  to  subscriptions,  advertising  or  address  changes,  manuscripts,  organizational  and  other  news  items  regarding  the  editorial  content 
to  the  editorial  and  business  office.  Subscriptions  are  available  for  $30  per  year,  paid  in  advance. 

COLORADO  MEDICINE  magazine  is  the  official  journal  of  the  Colorado  Medical  Society,  but  as  such  is  also  authorized  to  carry  general  advertising.  Publication  of  any  advertisement  in  COLORADO 
MEDICINE  does  not  imply  an  endorsement  or  sponsorship  by  the  Colorado  Medical  Society  of  the  product  or  service  advertised.  Published  articles  represent  opinions  of  the  authors  and  do  not  necessarily 
reflect  the  official  policy  of  the  Colorado  Medical  Society  unless  clearly  specified. 

Sandra  L.  Maloney,  Executive  Editor;  William  S.  Pierson,  Managing  Editor;  Michael  Thompson,  Asst.  Managing  Editor 
Member,  Colorado  Press  Association,  Member,  Colorado  Broadcasters  Association 


4 


Colorado  Medicine  for  January,  1993 


Photo  by  Rocky  Mountain  News 


Leigh  Truitt , MD 
President,  1992-1993 


President's 


How  to  compete  under  managed  competition 


We  do  not  yet  have  a definitive 
health  care  reform  proposal  from 
President-elect  Clinton.  In  Colorado, 
however,  we  are  already  studying 
ColoradoCare,  a managed  competi- 
tion approach.  In  this  model,  a single 
payer,  the  State  of  Colorado,  would 
give  a managed  care  network  a 
predetermined,  capitated  amount  to 
provide  care  for  those  citizens  who 
chose  that  particular  network. 

Most  observers  believe  that  the 
best  way  to  compete  under  such 
conditions  is  a health  maintenance 
organization.  Studies  have  shown 
that  staff  model  HMOs  are  currently 
more  cost  effective  than  their 
independent  practice  association 
counterparts.  Salaries  can  change 
incentives  from  providing  more 
services  to  providing  less. 

Does  this  mean  that  a vertically 
integrated  health  care  network  - with 
all  components  such  as  hospitals, 
specialists,  primary  care  physicians, 
etc.,  under  common  ownership  - is 
the  most  efficient  model?  Recent 
observations  in  other  industries 
suggest  that  the  opposite  is  true. 

Japanese  manufacturing  indus- 
tries have  typically  been  organized 
in  keiretsu,  "distributed  produc- 
tion" networks  of  many  separately 
owned  suppliers  with  one  core 
manufacturer  who  coordinates  the 
final  assembly  of  a motor  vehicle  or 
some  similar  product.  The  latest 
thinking  is  that,  if  these  networks 
become  too  closely  bound  together, 
the  relationship  can  become  "stale". 


As  a subcontractor  is  drawn  ever 
closer  to  the  core  company,  it 
can  become  over-specialized  and 
unable  to  compete  in  markets 
outside  the  network.  Worse,  it 
may  lose  the  innovative  edge  it 
gained  from  working  for  several, 
equally  demanding  customers.’ 

A further  problem  with  the 
traditional  pyramid-type  coalition, 
with  suppliers  working  exclusively 
with  one  core  manufacturer,  is  that 
total  dependence  on  one  network 
only  works  if  demand  for  the  core 
product  is  expanding.  During  times 
of  market  contraction,  suppliers  need 
to  insure  their  own  survival  by 
working  with  other  manufacturers 
and  by  selling  original  products. 

These  structural  changes  . . . will 
shortly  make  pyramid-type 
keiretsu  an  old-fashioned 
scheme.  Instead,  a distributed 
production  system  - optimizing 
networking  among  manufactur- 
ers and  parts  markets  - will 
become  the  norm.2 

The  fastest-growing  type  of 
physician  organization  is  the  single 
specialty  group.  The  most  rapidly 
expanding  type  of  HMO  is  the  IPA 
model.  This  development  speaks  for 
the  desire  of  physicians  to  maintain 
their  individualism  even  in  the  face 
of  pressures  for  greater  economic 
integration. 

If  single  specialty  groups  and 
individual  economic  incentives  are 
desirable  as  opposed  to  full  vertical 
integration,  how  can  we  attain  these 


//...  keiretsu,  'distributed 
production 1 networks  of 
many  separately  owned 
suppliers  ..." 


Colorado  Medicine  for  January,  1993 


7 


President's  Letter  (Continued) 

How  to  compete  under  managed  competition 


" People  want  to  identify 
with  something  closer  to 
them  and  of  human 
scale." 

' Organizations  need  to 
be  both  big  and  small  at 
the  same  time , be  they 
corporations  or  nations/ 


objectives  and  still  remain  cost 
effective?  Must  we  create  a tradi- 
tional pyramid-type  keiretsu  under 
the  domination  of  an  insurer  or  a 
hospital  system?  Or  do  we  need  a 
horizontal  network  of  distributed 
production  under  some  other 
paradigm? 

We  must  resolve  the  following 
paradox: 

[Organizations  need  to  be  both 
big  and  small  at  the  same  time, 
be  they  corporations  or  nations. 
On  the  one  hand,  the  economies 
of  scale  still  apply.  The  discovery 
and  development  of  new  sources 
of  oil  and  gas  require  resources 
that  no  small  niche  player  could 
contemplate.  Big  is  essential  as 
well  for  pharmaceutical  compa- 
nies if  they  are  to  finance  the 
massive  research  programs  on 
which  their  future  depends. 
Bigness  also  makes  an  organiza- 
tion less  dependent  on  a few 
crucial  people  or  on  outside 
expertise. 


At  the  same  time,  businesses  and 
nations  need  to  be  small.  Every- 
where small  nation  states  and 
regions  are  flexing  their  muscles 
and  demanding  more  autonomy. 
People  want  to  identify  with 
something  closer  to  them  and  of 
human  scale.  We  want  villages, 
even  in  the  midst  of  our  cities.  It 
is  no  different  in  organizations. 
Small  may  not  always  be  beauti- 
ful, but  it  is  more  comfortable.  It 
is  also  more  flexible  and  more 
likely  to  be  innovative.3 

Such  a solution  requires  understand- 
ing, cooperation  and  effort  on  the 
part  of  all  the  different  providers  of 
health  care.  We  can  learn  from 
looking  at  other  models  of  political 
and  industrial  organization. 

Ownership  isn't  always  the  best 
strategy. 

' "Why  networks  fail"  The  Economist,  October 
10,  1992,  p.  83 

2 Ikuo  Umebavashi,  "New  Trends  in  the  Keiretsu 

System"  The  Wali  Street  Journal,  November 
16,  1992,  p.  A12 

3 Charles  Handy,  "Balancing  Corporate  Power: 

A New  Federalist  Paper  Harvard  Business 
Review,  November-December,  1992,  p.  61 


Legal  Representation  before  the 
Colorado  State  Board  of 
Medical  Examiners 

Jeffrey  M.  La  ski 
Attorney  at  Law 
337-1400 


8 


Colorado  Medicine  for  January,  1993 


Comment 


Distribution 

At  its  meeting  of  December  1 6- 
1 7,  the  Copic  Board  received 
encouraging  news  from  its  actuaries: 
Losses  in  prior  years  are  developing 
more  favorably  than  predicted, 
producing  for  Copic  insureds  a 
profitable  1992  — and  the  surplus 
needed  to  fund  a 1993  policyholder 
dividend  of  $6,000,000.  As  you  view 
your  expenses  for  the  new  year,  each 
policyholder  may  plan  on  profes- 
sional liability  insurance  costs 
approximately  14%  less  than  you 
expected. 

The  1993  distribution  will  bring 
to  a total  of  $18.3  million  the  funds 
returned  to  policyholders  in  1990- 

93,  sound  evidence  of  our  basic 
corporate  policy  — that  any  and  all 
"profits"  are  returned  to  those  who 
are  paying  the  premium. 

Payment  will  be  made  as  two 
equal  premium  credits,  which  you 
will  see  on  invoices  at  May  1 5th  and 
September  15th,  1993. 


HIV  benefit 

In  a separate  mailing  to  all 
policyholders,  early  in  1993,  you 
will  receive  details  regarding  a 
policy  enhancement  for  insureds 
faced  with  the  professional  and 
financial  disaster  of  acquiring 
infection  with  HIV. 

At  no  additional  premium  cost, 
all  Copic  policyholders  will  be 
eligible  for  a one-time  benefit 
payment  of  $ 1 00,000  upon  provision 
of  proof  of  having  converted  to  an 
HIV  positive  serology,  or  being 
diagnosed  as  having  AIDS.  Any 
insured  physician  so  unfortunate  will 
also  be  counseled  regarding  existing 
statutory  or  regulatory  requirements 
for  practice  modification,  and  will 
remain  eligible  for  continuation  of 
their  professional  liability  insurance 
coverage  if  they  practice  within  the 
parameters  of  such  requirements. 

Watch  your  incoming  mail  for 
details;  if  you  have  questions  on  any 
aspect  of  these  policy  amendments, 
contact  your  own  policyholder 
representative  at  Copic. 


CompHealth,  the  nation's  premier  locum  tenens  organization,  now  provides  local 
primary  care  coverage  and  flexible,  part-time  opportunities  lor  physicians  in  the 
greater  Denver  area.  Call  today  to  discuss  daily,  weekly,  weekend,  evening,  or 
monthly  coverage  for  your  practice,  or  to  find  out  more  about  building  a tlexible 
locum  tenens  practice  right  here  in  the  greater  Denver  area. 


303-777-8002 

P.O.  Box  100218,  Denver,  CO  80250 


CompHeallh/Denver 

Local  Staffing  Network 


Copic  '93  distribution  set 
at  $6,000,000... 

Policy  amendments 
provide  HIV  benefit 


Colorado  Medicine  tor  January,  1993 


9 


Update:  Health  Care  Reform 


Health  care  reform  is  in  an 

There  is  probably  no  person  or  thing 
which  can  retrieve  health  care 
reform  from  this  bottomless  political 
chasm  for  at  least  the  next  1 20  days. 

The  abyss  is  the  fault  that  opens 
in  the  earth  crust  immediately  after 
presidential  elections  in  which  the 
incumbent  is  unseated.  Those 
campaign  promises,  those  critical 
electoral  issues  which  were  para- 
mount throughout  the  campaign  year 
suddenly  disappear  until  the  "first 
hundred  day  priorities"  are  set  by  the 
new  administration,  or  until  some 
enterprising  curmudgeon  (certainly, 
in  the  case  of  health  care)  reminds 
the  public  that  nothing  has  hap- 
pened. 

At  this  moment  in  political 
evolution  the  abyss  is  largest. 

What  were  the  last  words  on  the 
new  administration's  "health  re- 
form"? 

The  Clinton  Proposal* 

Key  Access  Mechanism 

• Require  phase-in  of  employer- 
provided  health  coverage  for 
employees 

• Implement  managed  competition: 
all  small  businesses  (with  up  to 

1 000  employees  under  Conserva- 
tive Democratic  Forum  [CDF] 
proposal)  must  buy  health  insur- 
ance through  state  health  insur- 
ance purchasing  cooperatives 
(HIPCs),  which  must  contract  with 
accountable  health  plans  (AHPs)  — 
networks  that  may  include  provid- 
ers and  insurers  — to  provide 
coverage  based  on  a standard 
premium  for  each  class  in  an  AHP 

• Probable  phase-in  of  program  as 
funds  become  available  due  to 
cost  savings. 


abyss. 

Secondary  Mechanism 

• Under  managed  competition,  poor 
and  low-income  given  subsidies  to 
buy  insurance  through  HIPCs 

Insurance 

• Require  community  rating 

• Under  CDF  managed  competition 
proposal,  AHPs  must 

* provide  uniform  set  of  effective 
benefits 

* require  cost-sharing 

* arrange  low-income  assistance 

* not  discriminate  based  on  health 
status 

* limit  pre-existing  conditions  to  6 
months;  no  exclusion  for  new- 
borns/pregnant women 

* set  standard  premium  for  each 
class 

Cost  Containment 

• Managed  competition**  rather 
than  price  controls  intended;  price 
controls  used  only  in  transition 
where  AHPs  have  not  developed 

• Federal  health  board  establishes 
annual  health  budget  targets 
nationally  and  by  state,  guides 
expenditures  in  public  and  private 
sectors,  and  establishes  core 
benefit  package  insurers  must 
provide,  including  ambulatory 
MD,  inpatient  hospital,  prescrip- 
tion drugs,  basic  mental  health, 
and  preventive  care 

•Reduce  drug  prices  by  eliminating 
tax  breaks  for  drug  companies 
raising  prices  faster  than  American 
income;  limit  deductibility  of  drug 
company  marketing/lobbying  costs 

• Control  unnecessary  use  of  tech- 
nology through  federal  health 
board's  recommendations/incen- 
tives for  sensible  capital  budgets, 
including  shared  use  of  technology 

• Provide  updated  medical  practice 
guidelines 


by  Bill  Pierson , Managing  Editor 


• Intensify  health  education  in 
home/school/workplace/senior 
centers  to  help  change  behaviors 

Financing 

• All  Americans  can  be  covered  with 
money  now  spent  on  health  care 

Medicare  Reform 

Long-Term  Care 

•Access  to  comprehensive  LTC  from 
Medicare  for  disabled  and  elderly, 
with  affordable/equitable  cost 
sharing  and  case  managers; 
phased-in,  beginning  with  home/ 
community  based  care;  respite 
care  to  help  relieve  families; 
remove  disincentives  for  commu- 
nity care,  making  nursing  home 
care  funding  available  for  home 
health,  adult  day  care,  transporta- 
tion 

• Through  new  National  Service 
Corps,  provide  college  loans  to  be 
paid  back  through  service,  includ- 
ing labor  in  LTC 

Liability  Reform 

• Alternative  dispute  resolution 
mechanisms  should  be  available  in 
every  state 

• Medical  practice  guidelines  can 
help  establish  better  guidelines  on 
what  constitutes  medical  malprac- 
tice 

Other 

•Accelerate  FDA  approval  process 

• Provide  adequate  inner  city/rural 
primary/preventive  care  clinics 

• Carry  out  NGA  recommendations 
to  provide  incentives  for  students/ 
health  professionals  to  provide 
primary  care  in  underserved  areas; 
expand  NHSC;  increase  support 
for  graduate  training  for  mid-level 
health  professionals  like  CNMs/ 
NPs 

• AMA  Division  of  Federal  Legislation  Group 
on  Legislative  Activities 

**  See  President's  Letter  - this  issue 


10 


Colorado  Medicine  for  January,  1993 


1992  elections  a success 


C0MR\C 


COMPAC  was  involved  in  69  State 
and  Federal  general  election  cam- 
paigns, contributing  $43,400  at  the 
state  level.  COMPAC  also  made 
recommendations  for  AMPAC  to 
contribute  $35,000  at  the  federal 
level  (excluding  independent 
expenditures.)  With  $78,400 
contributed  to  Colorado  candidates, 
COMPAC  finished  on  November  3rd 
with  a success  rate  of  81  %.  With 
the  redistricting  that  took  place  in 
1992,  this  is  quite  an  achievement. 
Here  is  how  it  all  breaks  down: 

Congressional  Races: 

Recommendations  were  made 
by  COMPAC  to  support  1 Demo- 
cratic campaign  and  3 Republican 
campaigns.  All  4 recommendations 
were  carried  out  by  AMPAC  and  all 
4 campaigns  were  successful. 
COMPAC  has  also  recommended 
$10,000.00  in  debt  retirement  for 
Democratic  Senator-elect  Ben 
Nighthorse  Campbell.  AMPAC  is 
currently  processing  this  recommen- 
dation. 

State  Senate  Races: 

COMPAC  supported  4 Demo- 
cratic senate  campaigns,  ail  of  which 
were  successful,  and  7 Republican 
senate  campaigns,  5 of  which  were 
successful.  COMPAC  also  supported 
an  additional  6 senators  who  ran 
unopposed  for  their  senate  seats, 
providing  assistance  in  mailing  to 
constituents.  Of  these  6 senators,  2 
were  Democrats  and  4 were  Repub- 
licans. 

State  House  of  Representatives: 

In  the  I louse,  COMPAC  sup- 
ported 17  Democratic  campaigns,  15 
being  successful,  and  23  Republican 


campaigns,  18  of  which  were 
successful.  COMPAC,  again  sup- 
ported an  additional  group  of 
representatives  running  unopposed. 
This  group  is  made  up  of  4 Demo- 
crats and  2 Republicans. 

C.  U.  Board  of  Regents: 

COMPAC  supported  one 
Republican  candidate  for  the  C.  U. 
Board  of  Regents,  a physician  and 
member  of  the  Colorado  Medical 
Society.  This  campaign  was  unsuc- 
cessful, but  a tight  race  to  the  end. 


"...a  success  rate  of  81%f/ 


Access  to  Food  Constitutes  a Human  Right 

World  hunger  is  an  ever-present  scourge  that  claims  35,000  lives  each  day. 

Access  to  food  constitutes  a human  right.  In  1 976,  the  United  States  Congress  passed  a 
Right  to  Food  Resolution  which  declared  the  sense  of  the  congress  to  be  "that  all  people 
have  a right  to  a nutritionally  adequate  diet'.' 

Physicians  Against  World  Hunger  (PAWH),  a non-profit,  tax-exempt  organization 
was  founded  so  that  physicians  could  collectively  defend  this  human  right  by  raising  funds 
to  support  well-recognized,  reputable  organizations  that  are  directly  engaged  in  working  with  the  poor  primarily 
for  the  purpose  of  ending  death  by  starvation. 

Please  join  us  — together  physicians  must  help  bring  an  end  to  world  hunger. 


Physicians  Against  World  Hunger 

#2  Stowe  Road,  Peek  ski  II,  NY  1 0566 

□ YES  I wish  to  join  PAWH  in  the  struggle  to  end  world  hunger  - enclosed  is  my  contribution. 

□ $50  O$100  □ $250  Ll  $500  flOther 


NAME  PLEASE  PRINT 


ADDRESS  CITY  STATE  ZIP 


SIGNATURE 

Please  forward  your  tax  deductible  contribution  to  Physicians  Against  World  Hunger  *2  Stowe  Road,  Peekskill,  NY  10566 


Colorado  Medicine  for  January,  1993 


The  Lobby 

What's  in 


it  for  me? 


Alan  Rapp,  MD,  Chairman 
Council  on  Legislation 


Colorado  59th  General  Assembly  Committees 


Listed  here  and  on  the  following  pages  are  all  of  the 
legislative  committees,  members  and  leadership  for  the 
1 993  session.  We  recommend  that  you  keep  these  pages 
for  reference  throughout  the  session. 


House  Health,  Environment,  Welfare 
and  Institutions  Committee 

Representative  Debbie  Allen  (R) 

923  S.  Ouray  St.,  Aurora,  CO  8001  7 
695-4920  Capitol  866-2936 

Representative  Mary  Blue  (D) 

37  Princeton  Cir.,  Longmont,  CO  80503 
772-3890  Capitol  866-2925 

Representative  Mary  Ellen  Epps,  Vice-Chairman  (R) 

21  7 Dexter  St.,  Colorado  Springs,  CO  8091 1 
(719)392-3861  Capitol  866-2946 

Representative  Daphne  Greenwood  (D) 

315  N.  Prospect  St.,  Colorado  Springs,  CO  80903 
(719)444-0115  Capitol  866-3069 

Representative  Rob  Hernandez  (D) 

4600  W.  36th  Ave.,  Denver,  CO  80212 
458-101  1 Capitol  866-2954 

Representative  Martha  Kreutz  (R) 

6023  S.  Bellaire  Way,  Littleton,  CO  80121 
741-4681  Capitol  866-2904 

Representative  Michelle  Lawrence  (R) 

6362  Depew  St.,  Arvada,  CO  80003 
420-7654  Capitol  866-2950 

Representative  Marcy  Morrison  (R) 

302  Sutherland  PL,  Manitou  Springs,  CO  80829 
(719)685-5929  Capitol  866-2904 

Representative  Alice  Nichol  (D) 

891  E.  71  st  Ave.,  Denver,  CO  80229 
287-7742  Capitol  866-2904 

Representative  Phil  Pankey,  Chairman  (R) 

5763  Shasta  Cir.,  Littleton,  CO  801  23 
798-5873  Capitol  866-2953 

Representative  Dan  Prinster  (D) 

P.  O.  Box  3884,  Grand  Junction,  CO  81  502 
241-5015  Capitol  866-2908 


Senate  Health,  Environment,  Welfare  and 
Institutions  Committee  (HEWI) 

Senator  Lloyd  Casey 

10434  Carmela  Ln.,  Northglenn,  CO  80234 
452-8515  Capitol  866-4865 

Senator  Sally  Hopper,  Chairman 

21649  Cabrini  Blvd.,  Golden,  CO  80401 
526-0785  Capitol  866-4873 

Senator  Elsie  Lacy,  Vice-Chairman 

1 1 637  E.  Mexico  Ave.,  Aurora,  CO  8001  2 
750-5943  Capitol  866-4866 

Senator  Donald  Mares 

2441  Perry  St.,  Denver,  CO  80212 
433-3559  Capitol  866-4865 

Senator  Dick  Mutzebaugh 

9965  S.  Wyecliff  Dr.,  Highlands  Ranch,  CO  80126 

791-4063  Capitol  866-4866 

Senator  Paul  Weissmann 

822  LaFarge  Ave.,  Louisville,  CO  80027 

673-0191  Capitol  866-4865 

Senator  Dottie  Wham 

2790  S.  High  St.,  Denver,  CO  80210 

757-0615  Capitol  866-4866 

House  Judiciary  Committee 

Representative  Jeanne  Adkins,  Chairman  (R) 

6517  N.  Pinewood  Dr.,  Parker,  CO  80134 
841-8829  Capitol  866-2936 

Representative  Celina  Benavidez  (D) 

2825  W.  34th  Ave.,  Denver,  CO  8021 1 
477-2867  Capitol  866-2925 

Representative  Diana  DeGette  (D) 

290  Elm  St.,  Denver,  CO  80220 
Capitol  866-2904 

Representative  Mary  Ellen  Epps  (R) 

21  7 Dexter  St.,  Colorado  Springs,  CO  8091 1 
(719)392-3861  Capitol  866-2946 

Representative  Doug  Friednash  (D) 

3371  S.  Magnolia  St.,  Denver,  CO  80224 
832-1900  Capitol  866-2904 


12 


Colorado  Medicine  for  January,  1993 


House  Judiciary  Committee  (Continued) 

Representative  Russ  George  (R) 

1300  E.  7th  St.,  Rifle,  CO  81650 
625-3778  Capitol  866-2904 

Representative  Moe  Keller  (D) 

4325  Iris  St.,  Wheat  Ridge,  CO  80033 
425-01  30  Capitol  866-2904 

Representative  Wayne  Knox  (D) 

761  S.  Tejon  St.,  Denver,  CO  80223 
934-8707  Capitol  866-2921 

Representative  Martha  Kreutz  (R) 

6023  S.  Bellaire  Way,  Littleton,  CO  80121 
741-4681  Capitol  866-2904 

Representative  Marcy  Morrison  (R) 

302  Sutherland  PI.,  Manitou  Springs,  CO  80829 
(719)685-5929  Capitol  866-2904 

Representative  Dorothy  Rupert  (D) 

680  Yale  Rd.,  Boulder,  CO  80303 
494-0568  Capitol  866-291  5 

Representative  Pat  Sullivan  (R) 

241 1 1 9th  Ave.,  Greeley,  CO  80631 
352-5066  Capitol  866-2929 

Representative  Shirleen  Tucker,  Vice-Chairman  (R) 

615  S.  Eldridge  St.,  Lakewood,  CO  80228 
988-01  1 8 Capitol  866-2923 

Senate  Judiciary  Committee 

Senator  Tom  Blickensderfer,  Vice  Chairman 

9 Parkway  Dr.,  Englewood,  CO  801 10 
758-0146  Capitol  866-4866 

Senator  Sam  Cassidy 

P.  O.  Box  1 29,  Pagosa  Springs,  CO  81 1 47 
Capitol  866-4865 

Senator  Regis  Groff 

2079  Albion  St.,  Denver,  CO  80207 
320-0495  Capitol  866-4865 

Senator  Sally  Hopper 

21649  Cabrini  Blvd.,  Golden,  CO  80401 
526-0785  Capitol  866-4873 

Senator  Elsie  Lacy 

1 1 637  E.  Mexico  Ave.,  Aurora,  CO  8001 2 
750-5943  Capitol  866-4866 

Senator  Dick  Mutzebaugh 

9965  S.  Wyecliff  Dr.,  Highlands  Ranch,  CO  80126 
791-4063  Capitol  866-4866 

Senator  Bob  Pastore 

536  Swede  Lane,  Monte  Vista,  CO  81  144 
(719)852-2795  Capitol  866-4853 

Senator  Linda  Powers 

P.  O.  Box  2300,  Crested  Butte,  CO  81224 
349-5798  Capitol  866-4865 

Senator  Dottie  Wham,  Chairman 

2790  S.  High  St.,  Denver,  CO  80210 
757-0615  Capitol  866-4866 


House  Appropriations  Committee 

Representative  Vickie  Agler 

1 0289  W.  Burgandy  Ave.,  Littleton,  CO  801  27 
973-1987  Capitol  866-2939 

Representative  Ken  Gordon 

2323  S.  Jackson,  Denver,  CO  80209 
753-1383  Capitol  866-2904 

Representative  Tony  Grampsas,  Chairman 

3237  S.  Hiwan  Dr.,  Evergreen,  CO  80439 
674-7883  Capitol  866-2957 

Representative  Tony  Hernandez 

I 285  S.  Clay  St.,  Denver,  CO  80219 
922-4388  Capitol  866-291  1 

Representative  Bill  Jerke 

23003  WCR  39,  LaSalle,  CO  80645 
284-6061  Capitol  866-2907 

Representative  Bill  Martin 

3110  Lees  Lane,  Colorado  Springs,  CO  80909 
(719)634-8729  Capitol  866-2965 

Representative  David  Owen,  Vice-Chairman 

2722  Buena  Vista  Dr.,  Greeley,  CO  80631 
330-9600  Capitol  866-2943 

Representative  Phil  Pankey 

5763  Shasta  Cir.,  Littleton,  CO  801  23 
7 98-5873  Capitol  866-2953 

Representative  Gil  Romero 

II  28  Catalpa  St.,  Pueblo,  CO  81001 
(719)544-2420  Capitol  866-258 7 

Representative  Gloria  Tanner 

2150  Monaco  Pky.,  Denver,  CO  80207 
355-7288  Capitol  866-2909 

Representative  Bill  Thiebaut 

P.  O.  Box  262,  Pueblo,  CO  81002 
(719)544-3822  Capitol  866-2922 

Senate  Appropriations  Committee 

Senator  Mike  Bird,  Chairman 

5810  Spurwood  Ct.,  Colorado  Springs,  CO  80918 
(719)594-9206  Capitol  866-4866 

Senator  Tilman  Bishop 

2697  G Road,  Grand  Junction,  CO  81506 
242-9230  Capitol  866-4866 

Senator  Sam  Cassidy 

P.  O.  Box  1 29,  Pagosa  Springs,  CO  81147 

Capitol  866-4865 

Senator  Joan  Johnson 

7951  York  St.  #3,  Denver,  CO  80229 

288-923 7 Capitol  866-4865 

Senator  Jana  Wells  Mendez 

P.  O.  Box  1 1 26,  Boulder,  CO  80306 

442-71 10  Capitol  866-4865 

Senator  Jim  Rizzuto 

Box  215,  La  Junta,  CO  81050 

(719)384-4465  Capitol  866-4865 

Senator  Jim  Roberts 

633  W.  6th  St.,  Loveland,  CO  80537 

663-1737  Capitol  866-4866 


Colorado  Medicine  for  January,  1993 


13 


Senate  Appropriations  Committee  (Continued) 


House  Leadership 


Senator  MaryAnn  Tebedo 

1916  Snyder  Ave.,  Colorado  Springs,  CO  80909 
(719)471-2561  Capitol  866-4880 

Senator  Claire  Traylor,  Vice-Chairman 

4045  Field  Dr.,  Wheat  Ridge,  CO  80033 
424-1  737  Capitol  866-4866 

Joint  Budget  Committee 

Senator  Mike  Bird,  Chairman 

581 0 Spurwood  Ct.,  Colorado  Springs,  CO  8091  8 

(719)594-9206  JBC  866-2587 

Representative  Tony  Grampsas 

3237  S.  FJiwan  Dr.,  Evergreen,  CO  80439 

674-7883  |BC  866-2061 

Representative  David  Owen 

2722  Buena  Vista  Dr.,  Greeley,  CO  80631 

330-9600  JBC  866-2061 

Senator  Jim  Rizzuto 

Box  21  5,  La  Junta,  CO  81050 

(719)384-8388  JBC  866-2587 

Representative  Gil  Romero 

1 1 28  Catalpa  St.,  Pueblo,  CO  81001 

(719)544-2420  JBC  866-2061 

Senator  Claire  Traylor 

4045  Field  Dr.,  Wheat  Ridge,  CO  80033 

424-1737  JBC  866-2587 

Senate  Leadership 

President  of  the  Senate  - Senator  Tom  Norton 

1 204  50th  Ave.,  Greeley,  CO  80634 
353-5360  Capitol  866-4866 

President  Pro  Tern  - Senator  Tilman  Bishop 

2697  G Road,  Grand  Junction,  CO  81506 
242-9230  Capitol  866-4866 

Majority  Leader  - Senator  Jeffrey  Wells 

524  S.  Cascade,  Suite  No.  1 , Colo.  Springs,  CO  80903 
Capitol  866-3341 

Assistant  Majority  Leader  - Senator  Ray  Powers 

5 N.  Marksheffel  Rd.,  Colorado  Springs,  CO  80929 
(719)596-1055  Capitol  866-4866 

Majority  Caucus  Chairman  - Senator  Bill  Schroeder 

4420  S.  Braun  Ct.,  Morrison,  CO  80465 
697-8321  Capitol  866-4866 

Minority  Leader  - Senator  Larry  Trujillo,  Sr. 

Suite  425  United  Bank  Bldg.,  Pueblo,  CO  81003 
(719)542-6912  Capitol  866-2318 

Assistant  Minority  Leader  - Senator  Jana  Wells  Mendez 

P.  O.  Box  1126  Boulder,  CO  80306 
442-71  10  Capitol  866-4865 

Minority  Caucus  Chairman  - Senator  Bob  Martinez 

6462  E.  63rd  Ave.,  Commerce  City,  CO  80022 
287-81  1 1 Capitol  866-4865 


Speaker  of  the  House  - Representative  Chuck  Berry 

314  Pine  Ave.,  Colorado  Springs,  CO  80906 
(719)634-6328  Capitol  866-2346 

Majority  Leader  - Representative  Tim  Foster 

593  Village  Way,  Grand  Junction,  CO  81  503 
245-8440  Capitol  866-2348 

Assistant  Majority  Leader  - Representative  Jeanne  Faatz 

2903  S.  Quitman  St.,  Denver,  CO  80236 
935-6915  Capitol  866-2966 

Majority  Caucus  Chairman  - Vacant  due  to  the  death  of 

Representative  John  Irwin 

Majority  Whip  - Representative  Vickie  Agler 

10289  W.  Burgandy  Ave.,  Littleton,  CO  80127 
973-1987  Capitol  866-2939 

Minority  Leader  - Representative  Sam  Williams 

Box  21  59  0982  FHigh  Point  Dr.,  Breckenridge,  CO  80424 
453-1586  Capitol  866-2920 

Assistant  Minority  Leader  - Representative  Peggy  Kerns 

1 1 24  S.  Oakland  St.,  Aurora,  CO  8001  2 
696-7178  Capitol  866-2919 

Minority  Caucus  Chairman  - Representative  Carol  Snyder 

1 1 756  Elati  Ct.,  Northglenn,  CO  80234 
452-7043  Capitol  866-4667 

Minority  Whip  - Representative  Vi  June 

7500  Wilson  Ct.,  Westminster,  CO  80030 
429-1  161  Capitol  866-2843 

Assistant  Whip  - Representative  Wayne  Knox 

761  S.  Tejon  St.,  Denver,  CO  80223 
934-8707  Capitol  866-2921 

Address  At  the  Capitol: 

The  Colorado  Senate  (or  Flouse  of  Representatives) 

State  Capitol 
Denver,  CO  80203 

KeyContacts  are  the 
right  combination 

With  many  new  faces  at  the  state  capitol,  physicians 
have  a chance  to  make  even  more  of  an  impact  on 
legislation  that  affects  medicine.  A personal  phone 
call  or  visit  from  a physician  can  make  a dramatic 
difference  in  a legislator's  opinion  and  actions, 
especially  if  that  physician  is  a constituent. 

| That  is  the  reason  behind  the  KeyContact 
program.  Each  legislator  is  assigned  one  or  more 
physician/constitutents  who  will  contact  that  law- 
maker on  critical  issues.  CMS  staff  provides  the 
physician  with  the  name  and  phone  number  of  his  or 
her  representative  and  alerts  the  physicians  when  a 
critical  issue  is  about  to  be  discussed. 

Take  this  opportunity  to  become  involved  in  one 
of  the  most  effective  grass  roots  lobbying  efforts 
going.  Call  (303)  779-5455  or  1-800-654-5653, 
extension  427  to  find  out  more. 


14 


Colorado  Medicine  for  January,  1993 


An  Open  letter  to  the  members  of  the 

Fifty  Ninth  Session  of  the 
Colorado  General  Assembly 


We  know  the  Colorado  legisla- 
tors have  been  subjected  to  a great 
deal  of  pressure  from  special  interest 
groups  to  legalize  lay  midwifery.  The 
Colorado  Gynecologic  and  Obstetric 
Society  is  opposed  to  this  action  and 
urges  you  to  stand  against  it. 

Home  delivery  in  1992  was  at 
best  archaic.  Physicians  and  hospi- 
tals who  oppose  lay  midwifery  have 
been  falsely  characterized  as  being 
interested  only  in  the  business 
aspect.  In  truth,  with  the  present 
shortage  of  physicians,  there  is  no 
lack  of  obstetric  patients.  The  real 
issue  is  that  mothers  and  babies  will 
be  harmed  by  this  practice.  In  the 
past  a leading  cause  of  death  in 
women  was  childbirth  complica- 
tions, and  the  newborn  death  rates 
were  extremely  high.  Modern 
medicine  has  changed  that,  and 
legalizing  lay  midwifery  would  be  a 
gigantic  step  backward  for  our 
society. 

There  are  many  deliveries  which 
are  accomplished  with  no  problems, 
but  the  risk  is  great.  There  are 
countless  documented  examples  of 
sudden  development  of  complica- 
tions when  the  results  would  be  a 
tragic  death  or  irreversible  damage 
for  the  mother  or  fetus  in  labor  not  in 
hospital.  Since  the  law  is  so  stringent 
regarding  abuse  and  injury  of 
children,  should  not  they  also  be 
protected  at  birth?  Why  should 
untrained  persons  be  allowed  to  put 
these  citizens  at  risk?  The  Colorado 
Gyn/OB  Society  is  unalterably 
opposed  to  passage  of  such  a bill. 
This  is  not  a question  of  choice  or 
access.  There  are  countless  choices, 
and  access  is  available  to  the 
community.  Please  remember  the 


maternal  mortality  rate  in  the  United 
States  was  over  1 per  100  births  and 
it  is  now  less  than  2 per  10,000.  If 
this  issue  is  enabled  by  law  passed 
through  your  legislture  it  will  have 
inevitible  adverse  maternal  and 
newborn  outcomes.  There  are 
standards  by  the  World  Health 
Organization  and  the  American 
College  of  Nurse  Midwives  concern- 
ing the  education  of  nurse  midwives 
which  the  American  College  of 
Obstetricians  and  Gynecologists 
endorses.  The  certified  nurse  mid- 
wife meets  these  standards.  Lower 
standards  are  unacceptable  for  care 
of  women  in  the  United  States.  The 
American  College  of  Obstetricians 
and  Gynecologists  has  issued  a 
statement  of  policy,  "supporting 
those  actions  that  improve  the 
experience  of  the  family  while 
continuing  to  provide  the  mother 
and  her  infant  with  accepted  stan- 
dards of  safety  available  only  in 
hospitals.  Labor  and  delivery,  while 
a physiologic  process,  clearly 
presents  potential  hazards  to  both 
mother  and  fetus  before  and  after 
birth.  These  hazards  require  stan- 
dards of  safety  which  are  provided  in 
the  hospital  setting  and  cannot  be 
matched  in  the  home  situation". 

If  you  do  pass  this  legislation, 
please  enact  another  bureaucracy 
which  requires  reporting  of  disasters 
that  come  through  the  Emergency 
Rooms  of  the  State  of  Colorado  so 
that  you  can  keep  a tally  on  the 
maternal  and  fetal  deaths  that  you 
have  enabled. 

Sincerely, 

Bruce  C.  Richards,  MD 


"If  this  issue  is  enabled 
by  law  ...it  will  have 
inevitible  adverse 
maternal  and  newborn 
outcomes. " 


Colorado  Medicine  for  January,  1993 


15 


by  Edie  K.  Register,  Director 
Jo  Parkin,  Program  Manager 


Health  Care 


Financing 


The  following  are 
responses  to  questions 
received  by  the  Health 
Care  Financing 
Administration  concerning 
implementation  of  the 
new  payment  policies  for 
surgical  procedures  as 
published  in  the  Medicare 
Bulletin  dated  December 
1 , 1 992.  Some  of  the 
questions  and  answers 
refer  to  the  rebundling 
initiative  and  columns  I 
and  II.  This  information 
was  published  in  the 
Medicare  Bulletin  dated 
December  31 , 1991. 


Endoscopy  Procedures 

Q:  Please  clarify  the  proper  billing 
of  endoscopies  performed  with 
multiple  biopsies  and/or  polyp- 
ectomies. For  example,  should  the 
code  for  colonoscopy  with  biopsy 
(45380)  be  billed  for  each  specimen 
taken  for  a biopsy?  Should  the  code 
for  colonoscopy  with  removal  of 
polypoid  lesions  (45385)  be  billed 
for  each  lesion  removed  in  conjunc- 
tion with  a colonoscopy?  If  so,  how 
should  payment  be  calculated  if 
multiple  biopsies  and  multiple 
polypoid  lesions  are  removed  during 
a colonoscopy? 

A:  Code  45380  should  be  billed 
only  once  for  all  specimens  collected 
and  biopsied  during  a single  colon- 
oscopy. This  code  represents  either  a 
single  or  multiple  biopsy.  Similarly, 
45385  designates  the  removal  of  a 
lesion  or  lesions  during  a colon- 
oscopy. Even  if  multiple  specimens 
or  lesions  are  removed  during  the 
colonoscopy,  the  physician  should 
bill  the  appropriate  code  only  once. 

If  both  45380  and  45385  are  billed, 
the  carrier  should  calculate  payment 
according  to  the  multiple  endoscopy 
rules. 

Q:  In  multiple  endoscopy  situations, 
carriers  are  instructed  to  pay  the  full 
value  of  the  highest  value  procedure 
plus  the  difference  between  the  next 
highest  and  the  base  endoscopy. 

How  should  carriers  apply  the 
multiple  endoscopy  rules  if  a physi- 
cian bills  only  for  the  base  procedure 
and  another  procedure  in  the  same 
endoscopic  series  (e.g.,  43235, 
upper  gastrointestinal  (Gl)  endos- 


copy, billed  with  43251 , upper  Gl 
endoscopy  for  removal  of  polypoid 
lesions)? 

A:  In  this  situation,  the  carrier  should 
pay  only  the  value  of  the  highest 
valued  procedure  (43251 ) since  this 
procedure  includes  the  base  (43235). 
Phase  II  of  the  rebundling  initiative 
includes  base  procedures  in  Column 
II  for  a number  of  endoscopies. Other 
endoscopies,  such  as  the  example 
cited  in  this  question,  did  not  meet 
the  monetary  threshold  for  inclusion 
in  Phase  II.  However,  even  if  the 
endoscopies  in  question  are  not 
included  in  the  mandatory  rebundl- 
ing edits,  carriers  should  not  pay 
twice  for  the  same  base  procedure. 

Q:  Some  endoscopies  other  than 
base  procedures  appear  in  Column  II 
for  another  endoscopy  in  the  same 
series.  For  example,  codes  29874 
(arthroscopy,  knee,  for  removal  of 
loose  body  or  foreign  body)  and 
29875  (arthroscopy,  knee,  synov- 
ectomy, limited)  are  Column  II  codes 
for  29876  (arthroscopy,  knee, 
synovectomy,  major).  Ail  Three 
codes  represent  knee  arthroscopies 
with  the  same  base  procedure  29870 
(arthroscopy,  knee,  diagnostic,  with 
or  without  synovial  biopsy).  How  do 
the  rebundling  edits  affect  the 
multiple  endoscopy  rules? 

A:  Carriers  must  first  apply  the 
rebundling  edits  to  determine  if 
payment  for  any  procedures  reported 
by  the  physician  must  be  denied.  For 
example,  if  a physician  reports  codes 
29874  and  29876,  the  carrier  may 
pay  only  for  code  29876.  In  this 
case,  the  multiple  endoscopy  rules 


16 


Colorado  Medicine  for  January,  1993 


would  not  be  a factor.  If  a physician 
reports  only  codes  29874  and 
29875,  payment  would  be  based  on 
the  full  value  of  the  higher  valued 
procedure  29874  plus  the  difference 
between  29875  and  the  base  proce- 
dure (29870). 

Ophthalmology 

Q:  Retinal  specialists  are  concerned 
about  payment  for  laser  eye  surgery 
(e.g.,  code  67141)  when  the  surgery 
is  done  in  phases.  Should  carriers 
pay  for  codes  which  describe 
multiple  sessions  only  once  during  a 
90-day  global  period? 

A:  Where  a descriptor  states  that  the 
code  represents  one  or  more  sessions 
of  a procedure,  carriers  may  pay  for 
that  service  only  once  during  the 
established  global  period.  The  work 
relative  values  (WRVs)  for  these 
codes  were  established  for  one  or 
more  sessions.  Examples  of  such 
procedures  are  contained  in  the  CPT- 
4 range  67141-67228. 

Q:  The  Ophthalmological  services 
in  the  CPT-4  range  92002-92499 
were  assigned  bilateral  indicators  of 
"0".  Should  the  correct  indicator  be 
"1 " so  that  carriers  can  adjust 
payment  when  a service  is  per- 
formed on  both  eyes? 

A:  The  correct  bilateral  indicator  is 
"0"  since  the  WRVs  were  established 
on  the  assumption  that  the  codes 
describe  bilateral  services.  Physi- 
cians should  use  the  reduced  service 
modifier  if  the  procedure  is  per- 
formed on  only  one  eye. 


Health  Care 


F 


I N A N C I N G 


Multiple  Surgery 

Q:  Do  the  multiple  surgery  or  co- 
surgeon rules  apply  if  two  physicians 
each  perform  separate  procedures 
during  the  same  operative  session 
(e.g.,  a general  surgeon  performs  a 
hernia  repair,  and  a urologist  per- 
forms prostate  surgery)? 

A:  Neither  the  multiple  procedure 
nor  co-surgeon  adjustments  apply  if 
two  physicians  each  perform  dis- 
tinctly different  surgeries  (with 
specific  CPT  codes)  on  the  same 
patient  on  the  same  day.  Modifier-51 
should  not  be  reported  for  these 
surgeries  unless  one  of  the  physi- 
cians individually  performs  multiple 
surgeries. 

Q:  A physician  may  attempt  to 
correct  a problem  and  avoid  a risky, 
extensive  surgery  by  performing  a 
less  extensive  procedure.  Occasion- 
ally, the  less  extensive  procedure  is 
unsuccessful,  and  the  surgeon  must 
perform  the  more  difficult  procedure 
within  the  postoperative  period  of 
the  original  surgery.  Is  payment  for 
the  second  surgery  limited  to  the 
intraoperative  percentage? 

A:  The  carriers  should  make  full 
payment  for  a surgery  performed 
during  postoperative  period  of  an 
unsuccessful  lesser  procedure.  This 
means,  the  payment  rules  for  the 
treatment  of  complications  do  not 
apply  to  this  situation.  The  physician 
should  bill  for  the  second  surgery 
with  modifier-79.  A new  global 
period  commences  with  the  second 
surgery. 


Q:  Anesthesiologists  may  be  paid 
separately  for  insertion  of  Swan- 
Ganz  catheters  and  other  specialized 
procedures.  When  an  anesthesiolo- 
gist bills  for  providing  the  anesthesi- 
ology services  and  insertion  of  the 
Swan-Ganz  catheter  (or  other 
procedure)  on  the  same  day,  do  the 
multiple  surgery  rules  apply? 

A:  The  multiple  surgery  rules  apply 
only  if  the  anesthesiologist  furnishes 
two  or  more  specialized  procedures 
on  the  same  day.  If  the  anesthesiolo- 
gist provides  only  the  anesthesiology 
services  and  insertion  of  a catheter, 
the  multiple  surgery  rules  do  not 
apply  to  the  insertion  of  the  catheter. 

NOTE:  Modifiers  -24,  -25,-78,  -79 
were  established  to  facilitate  physi- 
cian billing  and  carrier  processing. 
Services  provided  that  meet  the 
criteria  for  these  modifiers  should  be 
submitted  with  the  appropriate 
modifiers.  In  general,  carriers  have 
been  instructed  to  not  suspend 
services  reported  without  a modifier 
to  review  for  additional  documenta- 
tion. To  avoid  delays  and  possible 
denials,  please  utilize  the  modifiers 
when  appropriate.  Please  see 
Medicare  Bulletin  dated  January  2, 

1 992  for  explanation  of  use  of  these 
modifiers  for  Medicare  claims. 


Colorado  Medicine  for  January,  1993 


17 


y urni/,  ^ 

5 

a 

©*  S 

a 


/\  monthly  report  of 
current  and  on-going 
ctivities  of  the  Councils , 
Committees  and  Sections 
of  the  Colorado  Medical 
Society.  None  of  the 
information  herein  is 
meant  to  indicate  a policy 
or  position  statement  of 
the  Colorado  Medical 
Society.  This  report  is 
designed  only  to  inform 
CMS  members  of  their 
organization's  activities 
and  study  projects  at  the 
Council \ Committee  or 
Section  level. 


Council  on  Community  Health 
Issues: 

The  Council  reviewed  the  Poison 
Control  Center's  ongoing  funding 
problem  and  agreed  to  support  the 
concept  of  maintaining  the  Center  as 
it  now  stands,  recognizing  that 
Denver  should  not  have  to  support 
the  full  burden  of  the  Center's 
operating  costs.  The  Council  also 
reviewed  and  supported  the  HIV 
Committee's  recommendations 
regarding  anonymous  test  sites.  The 
Council  reviewed  and  approved  The 
Guide  to  Nursing  Home  Medical 
Director's  Job  Description  which  was 
an  attachment  to  Res-9-A:  Standards 
for  Medical  Directors  of  Nursing 
Homes  as  adopted  at  the  Annual 
Meeting  in  1 991 . Plans  for  dissemi- 
nation of  these  guidelines  were 
developed  for  implementation  after 
House  of  Delegates  approval  in 
March.  Also  reviewed  was  Res-54- 
P:  Study  Approaches  to  Reforming 
Nursing  Home  Care. 

Following  lengthy  discussions  it 
was  determined  that  the  Council 
does  not  have  the  expertise  to 
analyze  the  issues  proposed  in  this 
resolution.  It  was  suggested  that  an 
ad  hoc  committee  be  created  for  the 
sole  purpose  of  responding  to  this 
resolution. 

HIV  Committee: 

The  Council  is  providing  input  to 
the  CMS  Council  on  Ethical  and 
judicial  Affairs  regarding  Res-48-P: 
Treatment  of  HIV  Infections.  Res  48 
was  referred  to  the  Council  at  the 
1 992  Annual  Meeting.  The  next 
meeting  of  the  HIV  Committee  is 
scheduled  for  January. 


Family  Violence  Task  Force: 

The  November  meeting  was 
cancelled  due  to  inclement  weather. 
The  next  meeting  is  scheduled  for 
January  12,  1992.  A subcommittee 
is  in  the  process  of  planning  a 
multidisciplinary  forum  to  1 ) identify 
and  clarify  each  agency's  role,  2) 
clarify  the  existing  reporting  statute 
for  domestic  violence,  3)  identify 
problems  with  the  current  system  for 
dealing  with  domestic  violence,  and 
4)  problem  solve. 

Medical  Service  Council: 

At  the  December  meeting  of  the 
Council  members  reviewed  the 
proposed  rules  for  unlicensed  x-ray 
operators.  Their  comments  were 
referred  to  the  Government  Affairs 
Division.  The  Council  also  began 
developing  an  action  plan  for  the 
implementation  of  Res-68-P:  Creden- 
tialling  and  Peer  Review. 

Members  outlined  initial  infor- 
mation to  be  gathered  from  hospitals, 
COPIC  and  CFMC  prior  to  the  next 
meeting.  The  Council  approved  the 
draft  guidelines  for  the  locum  tenens 
project.  The  guidelines  will  be 
forwarded  to  legal  counsel  for 
review.  The  Council  also  recom- 
mended disbanding  the  pharmacy 
committee  suggesting  that  future 
pharmacy  issues  can  be  addressed 
by  the  Council  or  an  ad  hoc  commit- 
tee. 

In  addition,  a multidisciplinary 
task  force  has  begun  meeting  in 
response  to  Res-47-P:  Non-physician 
Medical  Care  Providers.  PAs,  Nurse 
Practitioners  and  physicians  are 
meeting  to  discuss  the  roles,  scope  of 
practice  and  supervisory  requ ire- 


18 


Colorado  Medicine  for  January,  1993 


merits  for  mid-level  providers  and 
how  these  issues  impact  access  to 
quality  care. 

Colorado  Health  Data  Commission 
Task  Force: 

The  task  force  has  been  reconsti- 
tuted to  include  the  CMS  executive 
committee  as  well  as  Drs.  John 
Farrington,  Ned  Calonge  and  Vern 
Smith.  The  task  force  has  met  once 
and  will  continue  to  meet  as  needed 
to  monitor  the  activities  of  the 
Colorado  Health  Data  Commission. 

Additional  Department  Activities: 

Codman  Small  Area  Analysis  Project: 

The  first  report  which  focuses  on 
medical  backs  and  back  and  neck 
procedures  is  complete.  A study 
committee  is  being  convened  to 
review  this  report  and  determine  the 
questions  raised  by  the  data.  This 
information  will  then  be  provided  to 
the  medical  community  to  assist 
them  in  understanding  and  utilizing 
the  data. 

Hospital  Medical  Staff  Section: 

The  HMSS  Section  will  hold  its 
next  meeting  in  January. 

Women  in  Medicine  Section: 

The  Section  continues  to  work 
on  sample  parental  policies.  They 
will  be  mailing  a questionnaire  to  all 
women  physicians  in  the  state  to 
inquire  about  what  the  Section  can 
do  for  them.  A mentor  program  for 
medical  students  is  being  developed. 
A ski  day  is  planned  for  January  27. 
The  Section's  Interim  Business 


Meeting  is  scheduled  for  April  2 in 
Colorado  Springs  in  conjunction 
with  the  CMS  Interim  Meeting.  Dr. 
Mary  Ann  Neifert  is  the  scheduled 
speaker.  The  next  meeting  of  the 
Governing  Council  is  scheduled  for 
January  28th. 


"...a  good  number  of 
complaints  from  health 
care  workers  about  non- 
compliance  in  medical 
offices' ' 


Important  OHSA  Update 


A recently  completed  AMA 
survey  of  the  OSHA  regional  offices 
and  state  programs  reinforced  our 
information  that  enforcement 
authorities  do  not  plan  to  perform 
random  physician  office  surveys  to 
determine  compliance  with  the 
standards  for  bloodborne  patho- 
gens. They  will  do  inspections  in 
response  to  complaints.  However, 
staff  at  a local  OSHA  offices  stated 
that  they  were  receiving  a good 
number  of  complaints  from  health 
care  workers  about  non-compliance 
in  medical  offices  which  will  be 
followed  up  with  inspections. 
Complaints  about  non-compliance 
are  frequent  in  the  following  areas: 

1 ) Lack  of  appropriate  personal 
protective  equipment  (i.e.  gloves, 
gowns,  masks,  etc.) 

2)  No  provision  for  Hepatitis  B 
vaccines  for  staff 

3)  Lack  of  an  exposure  control 

plan 


4)  Lack  of  training  for  office 
staff  in  areas  pertaining  to  the 
bloodborne  pathogen  standard  and 
office  policies  regarding  such 

One  additional  caution. 
Physicians  offices  often  hire  person- 
nel from  temp  services  but  do  not 
complete  an  exposure  determina- 
tion for  them  (job  classification 
regarding  potential  for  exposure  to 
bloodborne  pathogens)  and  do  not 
determine  whether  or  not  these  staff 
have  received  Hep  B vaccinations. 
Be  aware  of  what  jobs  you  are 
hiring  temps  for  and  whether  or  not 
they  are  in  a job  classification  with 
the  potential  for  exposure.  If  so  and 
if  they  will  be  with  your  office  for 
any  length  of  time,  consider  making 
appropriate  arrangements  for 
training  and  vaccination.  Check 
with  the  local  OSHA  offices  (844- 
5285  or  843-4500)  if  you  have 
questions. 


Colorado  Medicine  for  January,  1993 


19 


The  Interview 

A short  story  (Part  III  of  three  parts) 

by  Joe  Batuello,  MSI 

Denver,  Colorado 


" I'm  not  dead  yet." 

"You  will  be.  You'll  be  stone 
cold  in  a moment." 

"I  think  I'm  getting  better 

"You're  not  fooling  anyone, 
you  know." 


" What  a drag  it  is 

getting  old. . . " 


When  last  we  saw  Alex 
Bookman,  in  Part  II,  he 
had  just  concluded  his  in- 
terview with  Dr.  Zyklon 
considering  the  residency 
in  thanatology.  Alex  was 
on  a tour  of  the  California 
facility,  and  was  aware  of 
a room  labeled  the  " Pro- 
cedure Room".  Just  out- 
side the  room  was  a Nor- 
man Rockwell  portrait  of  the  boy  with 
his  bare  backside  fin  the  face  of  the 
doctor,  who  is  about  to  administer  a 
shot. 

"Interesting,"  thought  Alex  "that  a 
person's  dying  image  be  of  getting 
mooned  by  an  artist's  depiction  of  a 
trusting  patient." 

Alex  also  wondered  to  himself  what 
would  be  an  appropriate  soundtrack 
forone'sfinal  exit.  Maybe  "The  End"  by 
The  Doors?  Or  anything  by  Sinead 
O'Connor  so  you  would  want  to  be 
dead  that  much  more? 

Alex  peered  into  the  procedure  room. 
There  a table  in  the  center,  with  a 
cabinet  against  the  wall.  A couch  and 
some  wooden  chairs  were  clustered  at 
one  end  of  the  room,  presumably  for 
the  family.  The  walls  were  bare. 

A hospital  maintenance  employee 
swabbed  the  tile  floor,  whilea  portable 
radio  played  in  the  background.  Alex 
surveyed  the  room  thoughtfully,  trying 
to  imagine  what  it  was  like  while  the 
"procedure"  was  being  performed.  The 
music  from  the  radio  drifted  slowly 
into  Alex's  consciousness:  it  was  Pink 
Floyd's  "Comfortably  Numb."  At  that 
moment,  the  gestalt  was  almost  over- 
powering and  Alex  thought  he  would 
swoon. 


He  turned  back  into  the  hallway, 
experiencing  some  disorientation. 
From  one  of  the  rooms  his  attention 
was  taken  by  a familiar  dialogue, 
though  he  couldn't  quite  place  it.  The 
unmistakable  culture  of  British  accents 
flavored  the  conversation: 

"I'm  not  dead  yet." 

"You  will  be.  You'll  be  stone  cold 
in  a moment." 

"I  think  I'm  getting  better." 
"You're  not  fooling  anyone,  you 
know." 

Alex  peeked  into  the  room  to  see  a 
scene  from  "Monty  Python  and  the 
Holy  Grail"  on  the  television.  He  re- 
membered the  scene:  a man  is  drawing 
a cart  in  a medieval  village  collecting 
victims  from  the  plague.  A citizen 
approaches  him  with  a "not  quite  dead" 
victim  and  tries  to  get  the  cart  bearer  to 
accept  the  cargo.  "I  can't  take  'em  like 
that,"  explains  the  cart-bearer,  "it's 
against  regulations."  After  some  per- 
suading the  cart  man  agrees  to  help  the 
reluctant  cargo  is  clubbed  over  the 
head  and  piled  onto  the  cart. 

"Hmmm,"  reflected  Alex.  "Maybe 
Dr.  Zyklon's  program  isn't  so  innova- 
tive after  all." 

As  Alex  headed  down  the  elevator 
and  out  of  the  building,  he  was  still 
confused  about  his  residency.  Hedidn't 
think  he  would  like  thanatology. 

He  loosened  his  tie,  slid  into  his 
rented  car  and  started  the  engine.  The 
radiocameon  with  a melodic  observa- 
tion from  the  Rolling  Stones:  "What  a 
drag  it  is  getting  old..." 


20 


Colorado  Medicine  for  January,  1993 


Board  Highlights 

Highlights  of  the  CMS  Board  of  Directors  meeting 
November  22,  1992 


CMSA: 


Medical  Student  Society: 


Executive  Committee: 


Finance  Committee: 


Board  of  Directors: 


Mrs.  Pam  Laman,  President,  reported  that  the  Denver  Medical  Society 
Auxiliary  had  distributed  over  10,000  pamphlets  on  Domestic  Violence  and 
that  Otero  County  was  developing  an  awareness  program  on  the  same 
subject. 

Maura  Lofaro,  MSIV,  reported  that  the  MSS  had  held  its  first  meeting  and 
elected  officers. 

The  Board  ratified  the  actions  of  the  Executive  Committee  in  deciding  to  hold 
both  an  Interim  Meeting  and  a Leadership  Conference.  Also,  Ms.  Maloney 
has  been  directed  to  negotiate  with  the  Colorado  Dept,  of  Health  for  CMS  to 
be  the  facilitator  for  the  distribution  of  Do  Not  Resuscitate  forms. 

The  Board  ratified  the  actions  of  the  Finance  Committee  in  approving  requests 
for  distribution  of  monies  from  the  Colorado  Medical  Foundation  Trust  to  the 
Colorado  Physician  Health  Program,  the  Colorado  Personalized  Education 
Program  and  to  CMSERF. 

The  Board  approved  Dr.  Truitt's  recommendation  to  create  a Task  Force  for 
the  purpose  of  study  and  monitoring  the  ongoing  health  care  reform  activities, 
both  on  a state  and  federal  level. 

It  was  announced  that  Dr.  Don  Parsons,  a long-time  active  member  of  CMS 
had  accepted  a position  in  the  legislative  division  of  Kaiser  Permamente  in 
Washington,  D.C.  His  expertise  in  this  arena  in  Colorado  will  be  missed. 


Volunteer  Doctors 

The  Salvation  Army  Adult 
Rehabilitation  Center  at  4751 
North  Broadway  (1-25  to  49th 
Avenue  exit  to  Broadway  and 
right  to  4751 ) is  looking  for 
retired  physicians  who  are 
interested  in  volunteering  some 
time  and  medical  services. 

If  you  or  any  retired  physician 
you  know  is  interested,  please 
call 

Connie  Schranz 
Salvation  Army 
Adult  Rehabilitation  Center 
in  Denver  at  294-0827. 


Jo  Parkin 


CMS  is  pleased  to  introduce  a 
new  employee  in  the  Health  Care 
Financing  Department. 

Jo  Parkin  comes  to  us  from  Blue 
Cross  Blue  Shield  of  Colorado  where 
she  was  a Network  Administrator  for 
Colorado,  New  Mexico  and  Nevada. 


Jo  has  ten  years  experience  in  the 
health  care  field.  She  has  recently 
received  her  masters  degree  in  health 
care  systems,  lo's  responsibility  at 
CMS  will  be  to  deal  with  third  party 
payer  issues.  She  will  be  assisting 
CMS  physicians  members  with 
Workers'  Compensation,  Auto  No- 
Fault  and  private  Insurance  issues. 

Jo  will  also  be  responsible  for 
disseminating  information  and 
advice  to  the  membership  pertaining 
to  current  and  new  laws,  regulations 
and  policies  emanating  from  federal, 
state  and  local  agencies  and  third 
party  payers. 


Colorado  Medicine  for  January,  1993 


Introducing 

1992-1993  Board  of  Directors 

Photos  by  Gill  Maestas,  II,  except  for  Dr.  Truitt,  photo  by  Rocky  Mountain  News 


Dr.  Leigh  Truitt,  1993 
President  of  the  Colo- 
rado Medical  Society 
has  been  a member  for 
the  past  22  years.  He 
earned  his  MD  degree 
in  1964  from  Johns 
Hopkins  Medical 
School  and  specializes 
in  Internal  medicine 
and  Pulmonary  Dis- 
eases. 

Wm.  Carl  Bailey,  MD  currently  serves  as 
President-Elect  of  1 992-93 
oftheColorado Medical  So- 
ciety. Dr.  Bailey  recieved 
his  Medical  Degree  in  1952 
from  the  Wayne  State 
Universtiy  Medical  College 
in  DetroitMichigan.  He  has 
been  a member  of  CMS  for 
the  past  34  years  and  spe- 
cializes in  Pediatric  Surgery. 

Dr.  Harrison  G.  Butler  III  is  the  Immediate 
i Past  President  of  CMS.  He 

years.  Dr.  Butler  recieved 

Dr.  Terrance  Sullivan  has 

been  a member  of  CMS  for 
the  past  8 years.  He  serves 
as  treasurer  for  the  Colo- 
rado Medical  Society  Board 
of  Directors.  Dr.  Sullivan 
specializes  in  Occupa- 
tional Medicine. 

Thomas  J.  Allen,  MD  has  been  a member  of 
TheColorado Medical  So- 
ciety forthe  past  18  years. 
He  recieved  his  Medical 
Degree  in  1972  from  In- 
diana University  and  spe- 
cializes in  Family  Prac- 
tice, Emergency  Medicine 
and  Occupational  Medi- 
cine. 

John  O.  Cletcher  Jr,  MD  has  been  a mem- 
ber of  CMS  for  the  past  28 
years.  He  recieved  his  Medi- 
cal Degree  in  1 955  from  the 
University  of  Illinois.  Dr. 

Cletcher  practices  Orthope- 
dic Surgery  and  is  based  in 
Longmont  CO. 


Donald  G.  Eckhoff,  MD 

is  a Denver  physician 
who  specializes  in  Or- 
thopedic Surgery.  Dr. 

Eckhoff  has  been  a CMS 
member  for  1 5 years.  He 
recieved  his  Medical  De- 
gree from  the  University 
of  Minnesota  and  served  his  internship  at 
Saint  Lukes  Hospital  in  Denver. 

Dr  John  E.  Elliff  has  been 
a Member  of  the  Colo- 
rado Medical  Society  for 
the  past  38  years.  He  stud- 
ied at  and  earned  his 
Medical  Degree  from  the 
University  of  Colorado 
School  of  Medicine  in 
1 956.  He  currently  practices  Ophthalmol- 
ogy in  Sterling  CO. 

Vail  Colorado  is  the  home 
Feeney,  MD.  Dr.  Feeney 
specializes  in  Family  Prac- 
tice and  has  been  a mem- 
ber of  CMS  for  9 years.  He 
recieved  his  Medical  De- 
gree in  1 977  and  served  his 
internship  and  residency  at 
St.  Paul  Ramsey  Hospital 
in  Minnesota. 

Dr.  David  C.S.  Franklin  earned  his  Medical 
Degree  ^in  South  Africa  at 

‘ where  he  practices  Anes- 
thesiology. 

In  addition  to  a thriving  adult  and  pediatric 
allergy  and  asthma  prac- 
tice, Joel  M.  Karlin,  MD  is 
an  alternate  delegate  to  the 
American  Medical  Asso- 
ciation from  Colorado  and 
represents  the  Clear  Creek 
Valley  Medical  Society  on 
the  CMS  Board  of  Direc- 

George  M.  Kreye,  MD  received  his  Medi- 
cal Degree  from  the  Uni- 
versity of  Kansas  Medical 
School  in  1 962  and  com- 
pleted an  internship  at 
Fitzsimons  General  Hos- 
pital in  Aurora  CO.  He 
has  been  a member  of  the 
CMS  for  26  years. 
Dr. Kreye  specializes  in 

Dermatology. 


Muryl  L.  Laman  received 
h is  h i s Doctorate  of  Med  i- 
cine  from  the  University 
of  Kansas.  In  addition  to 
serving  as  the  Pueblo 
County  representative  to 
the  CMS  Board  of  Direc- 
tors, Dr.  Laman  practices 
Cardiology,  Internal  Medicine  and  Aero- 
space Medicine  in  Pueblo.  His  wife,  Pam, 
is  currently  President  of  the  CMS  Alliance, 
a physician  spouse  organization. 

Dr.  Ted  T.  Lewis  is  a Rheumatologist  from 
Colorado  Springs,  Colo- 
rado. Dr.  Lewis  received 
his  medical  degree  from 
the  State  University  of 
Virginia,  but  has  done  all 
his  post-doctorate  work 
at  he  University  of  Colo- 
rado. He  represents  El 
Paso  County  Medical 
Society  on  the  CMS  Board  of  Directors. 

Robert  A.  Nathan,  MD  has  been  a member 
of  the  Colorado  Medical 
Society  for  fifteen  years. 
He  represents  the  El  Paso 
County  Medical  Society 
on  the  CMS  Board  of  Di- 
rectors. Dr.  Nathan  spe- 
cializes in  Allergy  & Im- 
munology in  Colorado 
Springs.  He  received  his 
MD  from  the  University  of  Miami. 

Dr.  Kenneth  M.  Olds  is  a 

ner  from  Greeley,  Colo- 
rado. He  represents  the 
Weld  County  Medical 
Society  on  the  CMS  Board 
of  Directors.  Dr.  Olds  has 
been  a member  of  the 
Colorado  Medical  Soci- 
ety for  1 9 years. 

Lothar  K.  Roller,  MD  came  to  Colorado 
after  earning  a Medical 
Degree  at  the  University 
of  Heidelberg  in  Ger- 
many. He  has  been  a CMS 
member  for  29  years.  Dr. 
Roilerpractices  in  Canon 
City  CO.  where  he  spe- 
cializes in  Radiology  and 
Nuclear  Medicine. 
David  Shander,  MD  is  a Denver  physician 
who  specializes  in  Car- 
diovascular Diseases.  Dr. 

Shander  received  his 
Medical  Degree  from  the 
University  of  Rochester 
in  New  York  and  has  been 
a member  of  CMS  for  1 7 
years. 


Photo  not 
available 


of  Jonathan  C. 


Photo  not 
available 


Photo  not 
available 


Family  Practitio- 


Photo  not 
available 


Photo  not 
available 


22 


Colorado  Medicine  for  January,  1993 


1992-1993  Board  of  Directors 


I has  lx vn  ,i  ( MS  member 
. iS  f°r  ' ^ years.  After  receiv- 
ing  a Medical  Degree  from 
Temple  University  in  Phila- 
del phi,i,  Dr.  Shanks  came 
j^iPI  to  Denver  and  completed  a 
residenecy  at  St.  loseph 
Hospital.  He  lives  in  Grand  junction  CO. 
where  he  practices  General  Surgery. 

Susan  A.  Sherman,  MD  is 

sician  who  specializes  in 
Internal  Medicine,  Endo- 
crinology & Metabolism, 
and  Diabetes.  Dr.  Sher- 
man earned  her  Medical 
Degree  in  1973  from  the 
University  of  North  Caro- 
lina and  completed  her 
internship  and  residency 
at  Presbyterian  University  Medical  Center 
in  Pennsylvania.  She  has  been  a member  of 
CMS  for  1 6 years. 

Denis  J.  Winder,  MD  is  a Durango  CO. 
1 3 years. 

M.  Robert  Yakely,  MD  has  been  a member 
ofCMSforthepast21  years. 

After  receiving  his  Medical 
Degree  Dr.  Yakely  com- 
pleted an  internship  at  the 
Ohio  State  University  Hos- 
pital followed  by  his  resi- 
dency at  the  University  of 
Colorado  School  of  Medi- 
cine. He  currently  practices 
in  Denver  where  he  is  a specialist  of  Uro- 
logical Surgery.  Dr.  Yakely  is  a past  chair- 
man of  the  CMS  Council  on  Legislation. 


Cardiologist  Dieter  W.  Schneider,  MD  has 

been  a member  of  the 
Colorado  Medical  Soci- 
ety since  1 983.  Dr. 
Schneider  graduated 
from  the  University  of 
Colorado  School  of  Medi- 
cine and  served  as  an  in- 
tern and  resident  at  St. 
Luke's  Hospital  in  Den- 
ver. He  represents  the  Young  Physicians 
Section  of  CMS  on  the  Board  of  Directors. 


Dr.  Gary  D.  VanderArk  is 

proud  of  his  work  at  the 
Colorado  Neurological  In- 
stitute in  Denver,  but  is  also 
concerned  with  organized 
medicine.  That  is  why  he 
represents  the  Hospital 
Medical  Staff  Section  on  the 
CMS  Board  of  Directors.  Dr.  VanderArk 
was  awarded  the  Doctor  of  Medicine  by 
the  University  of  Michigan  in  Ann  Arbor 
and  received  the  Robins  Award  for  Com- 
munity Service  by  a Physician  from  the 
Colorado  Medical  Society. 

Louise  L.  McDonald  was  granted  the  de- 
greeof  Medical  Doctor  by 
Georgetown  University 
School  of  Medicine  in 
Washington  DC.  She  did 
her  internship  and  resi- 
dency training  at  Harbor 
General  Hospital  in  Tor- 
rance California  and  cur- 
rently is  a practicing  Pediatrician  in  Den- 
ver. She  works  at  the  University  of  Denver 
Student  Health  Service.  Dr.  McDonald  rep- 
resents the  Women  in  Medicine  Section  on 
the  Board  of  Directors. 

Stephen  G.  Batuello  became  active  in  or- 
ganized medicine  as  a 
student  at  the  University 
of  Colorado  School  of 
Medicine  and  served  as 
the  student  representative 
to  the  Board  of  Directors 
until  his  graduation  last 
spring.  Currently  under- 
taking a surgical  residency,  he  stayed  on 
the  Board  as  the  representative  of  the  Resi- 
dent Physicians  Section. 

Maura  J.  Lofaro  is  currently  a senior  medi- 
cal student  at  the  Uni- 
versity of  Colorado.  She 
plans  to  specialize  in 
Obstetrics  and  Gynecol- 
ogy when  she  graduates 
this  spring.  Until  then, 
she  will  continue  to 
serve  as  the  Medical  Stu- 
dent Component  repre- 
sentative on  the  CMS  Board  of  Directors. 
M.  Ray  Painter,  MD  has  been  a member  of 
the  Colorado  Medical  Soci- 
ety for  22  years.  Specializ- 
ing in  Urological  Surgery, 

Dr.  Painter  did  his  intern- 
ship and  residency  work  at 
Triplet  Army  Hospital  in 
Hawaii.  Currently  practic- 
ing in  Glenwood  Springs, 

Dr.  Painter  is  a member  in 
good  standing  in  the  Mt.  Sopris  County 
Medical  Society.  He  is  a delegate  to  the 
American  Medical  Association  from  Colo- 
rado. 


In  addition  to  representing  Colorado  at  the 
American  Medical  Asso- 
^ H ciation  meetings.  Dr. 

■ Richert  E.  Quinn,  Jr.  is  a 
I member  of  the  Board  of 
I Directors  of  Copic  Insur- 
HH  ance  and  a Past  President 
of  the  Colorado  Medical 
Society.  In  his  free  time, 
Dr.  Quinn  operates  a gen- 
eral surgery  practice  in  Greeley.  He  has 
been  a CMS  member  for  22  years. 


After  receiving  his  medical  degree  from 
Temple  University  School 
of  Medicine  in  Pennsyl- 
vania, Mark  A.  Levine 
served  an  internship  atthe 
University  Hospital  there 
before  coming  to  Colo- 
rado for  a residency  atthe 
CU  School  of  Medicine. 

He  currently  practices  In- 
ternal Medicine  and  Allergy  & Immunol- 
ogy in  Englewood  and  represents  the  Colo- 
rado Medical  Society  in  the  AMA  House  of 
Delegates.  Dr.  Levine  has  been  a member 
of  the  CMS  for  20  years. 


In  addition  to  his  duties  as  an  alternate 
delegate  to  the  AMA  from 
Colorado,  Dr.  Robert  D. 
McCartney  Chairs  the 
Council  on  Physician/Pa- 
tient Advocacy  of  the  CMS, 
where  he  has  been  a cham- 
pion of  the  elderly  patient. 
He  does  much  community 
work  in  this  area  and  is  a 
specialist  in  Internal  Medicine  and  Geriat- 
rics in  Denver.  Dr.  McCartney's  education, 
including  internship  and  residency  was 
completed  at  the  University  of  Colorado, 
he  joined  the  Colorado  Medical  Society  in 
1981. 


Dr.  Robert  M.  Bogin  has  been  active  in  the 
Young  Physicians  Section 
on  both  national  and  state 
levels.  He  currently  is  an 
alternate  delegate  to  the 
American  Medical  Asso- 
ciation from  the  CMS  and 
specializes  in  Internal 
Medicine  and  Pulmonary 
Diseases  in  Denver.  Dr. 

Bogin  was  awarded  the  MD  degree  from 
Cornell  University  in  New  York  and  served 
his  internship  and  residency  at  the  Univer- 
sity of  Michican  Hospital  in  Ann  Arbor. 


a Colorado  phy- 


Photo  not 
available 


Photo  not 
available 


Photo  not 
available 


Colorado  Medicine  for  January,  1993 


23 


Medical 


News 


Cancer  Help 
Available 

In  today's  world  of  modern  medi- 
cine, a diagnosis  of  cancer  is  no 
longer  a reason  to  despair.  Recent 
advances  in  science  have  enabled 
physicians  not  only  to  treat  but  in 
some  cases  cure  many  forms  of 
cancer 

Since  cancer  will  strike  three  out 
of  four  American  families  every  year, 
the  Cancer  Research  Institute  would 
like  to  ask  you  to  lend  your  support 
to  an  organization  and  a publication 
that  figure  importantly  in  the  ongoing 
effort  to  control  the  disease. 

The  Institute  is  a not-for-profit 
corporation,  founded  in  1953  to 
support  research  in  the  field  of 
cancer  immunology.  Known  for  its 
scientific  excellence  and  fiscal 
integrity,  this  farsighted  organization 
offers  the  Help  Book  as  its  first 
venture  into  the  outpatient  services 
area. 

The  HelpBook  is  a 44-page 
booklet  intended  to  assist  cancer 
patients  and  their  families  in  coping 
with  their  illness.  It  is  an  exception- 
ally valuable  guide  that  presents  an 
eight-step  plan  for  patients  to  follow 
from  diagnosis  through  recovery.  The 
booklet  gives  clear,  concise,  easy-to- 
read  advice  on  getting  the  best 
medical  care,  how  to  obtain  a 
second  opinion,  how  to  seek  out 
sources  of  needed  treatment,  how  to 
obtain  ancillary  services  and  even 
gives  information  on  financial 
considerations. 

Dr.  lill  O'Donnell-Tormey,  co- 
author of  the  HelpBook,  sought 
advice  from  leading  oncologists 


drawn  from  the  Institute's  Scientific 
Advisory  Council  that  includes  four 
Nobel  laureates  and  17  members  of 
the  National  Academy  of  Sciences  to 
assure  the  validity  of  the  booklet. 

The  Institute  will  make  these  book- 
lets available  to  physicians  to 
distribute  in  their  offices  for  a small 
shipping  and  handling  charge.  To 
order,  call  the  Institute  at  1-800- 
99CANCER. 

National  Physician 
Group  Enters 
Colorado  Politics 

The  American  Association  of  Physi- 
cians for  Human  Rights  (AAPHR),  a 
group  of  lesbian  and  gay  physicians 
and  supporters  based  in  California, 
has  announced  that  it  will  join  other 
groups  in  a boycott  of  Colorado  over 
the  passage  of  Amendment  2.  The 
association  canceled  their  plans  to 
hold  their  annual  convention  in 
Denver  in  August  and  called  for 
other  organizations  to  boycott 
Colorado  as  well. 

The  group  said  this  is  the  first 
time  in  their  history  that  a major 
meeting  has  been  rescheduled  in 
response  to  a political  decision.  Larry 
Prater,  MD,  AAPHR  President,  said 
"We  cannot  in  good  conscience 
bring  our  members  and  our  dollars  to 
a state  that  would  so  willingly  deny 
basic  civil  rights  to  lesbian  and  gay 
people." 

Amendment  2,  supported  by 
over  800,000  Colorado  voters 
November  3,  prohibits  government 
entities  from  adding  "sexual  orienta- 
tion" to  the  list  of  classes  of  people 
who  receive  special  protection  from 


discrimination.  The  list  presently 
includes  such  groups  as  women, 
racial  minorities,  and  natives  of  other 
countries,  all  of  whom  have  required 
protection  from  a history  of  past 
discrimination. 

Cheryl  Clark,  MD,  a Denver 
psychiatrist  who  serves  on  the  board 
of  AAPHR,  said,  "It's  a shame  that 
the  citizens  of  my  state  gave  in  to 
pressure  from  the  religious  right.  This 
will  adversely  affect  the  health  and 
well-being  of  thousands  of  Colorad- 
ans." 

Local  columnist  Al  Knight, 
writing  in  the  Denver  Post,  disagreed 
with  this  prediction  of  disastrous 
effects,  saying  that,  in  practical 
terms,  all  that  changed  was  the 
elimination  of  three  local  ordinances 
and  one  executive  order  prohibiting 
discrimination  against  people  on  the 
basis  of  their  sex  lives.  Knight 
discounted  the  contention  that 
passage  of  this  amendment  signals 
an  era  of  hate  against  homosexuals, 
"It  is  said  that  Coloradans  want  to 
discriminate  against  homosexuals.  It 
is  much  more  likely  that  hundreds  of 
thousands  of  them  did  not  want  to  be 
taken  on  a guilt  trip.  Many  know 
nothing  of  homosexuality  and  are 
unaware  of  any  action  on  their  part 
that  would  in  any  way  affect  the  lives 
of  homosexuals.  Many  others  simply 
reject  the  notion  that  sexual  orienta- 
tion should  be  considered  in  the 
same  legal  class  with  race  and 
ethnicity." 


24 


Colorado  Medicine  for  January,  1993 


Child  Abuse 
Training 

The  Denver  Osteopathic  Foundation 
and  Presbyterian/St.  Luke's  Family 
Medicine  Program  will  offer  a one 
day  training  session  for  family 
physicians  on  Child  Sexual  Abuse 
and  Neglect  February  27.  Dr.  Carole 
Jenny  of  the  Children's  Hospital  will 
be  conducting  the  program  at 
Denver  Presbyterian  Hospital 
Auditorium.  Call  364-2273  for  more 
information. 

Colorado  Trust 
Begins  $4.5  Million 
Community  Health 
Initiative. 

Thirteen  communities  across  Colo- 
rado have  been  selected  to  begin  a 
five  year  project  called  Colorado 
Healthy  Communities  Initiative. 
Begun  by  the  Trust  in  response  to  the 
findings  of  the  Choices  for  Colo- 
rado's Future  study,  the  Initiative 
responds  to  a desire  for  local  action 
and  participation  to  respond  to 
community  needs  through  commu- 
nity-based approaches  to  problem 
solving. 

The  Trust  has  contracted  with 
the  National  Civic  League  to  manage 
the  program  in  Commerce  City, 

Delta  and  Montrose  counties,  Gilpin 
County  and  the  Nederland  mountain 
area,  Globeville,  Gunnison  basis,  La 
Plata,  San  Juan  and  Archuleta 
counties,  Las  Animas  County,  Mesa 
County,  Montezuma  County  (includ- 
ing the  Ute  Mountain  Tribe),  North- 
east Colorado  (Logan,  Morgan, 


Medical 


News 


Phillips,  Sedgwick,  Washington  and 
Yuma  counties),  Pueblo  County, 
(Roaring  Fork  Forum  (Aspen  to 
Parachute),  and  the  Telluride  region. 
Up  to  30  communities  will  ulti- 
mately be  selected  for  the  project 
over  the  next  two  years.  Contact  the 
Colorado  Trust  for  more  information 
at  (303)  837-1200. 

Feds  Consider 
Electronic  Records 
Requirement 

Bills  introduced  at  this  past  session  of 
the  U.S.  Congress  included  provi- 
sions to  require  all  Medicare  provid- 
ers to  have  computerized  patient 
record  systems  Observers  expect  the 
Clinton  administration  to  accelerate 
efforts  toward  electronic  patient 
record  systems. 

To  help  physicians  cope  with 
these  changes,  the  Medical  Records 
Institute  is  sponsoring  TOWARD  AN 
ELECTRONIC  PATIENT  RECORD  - 
1993,  to  be  be  held  April  21-24, 

1993  in  San  Antonio,  Texas.  Call 
Shirley  Tow  at  (61  7)  964-3923. 

New  Hope  in  Anti- 
Trust  Arena 

A recent  court  decision  in  the  much 
publicized  case  of  three  Florida 
dentists  accused  of  criminal  price 
fixing  gives  some  hope  to  belea- 
guered health  professionals. 

Currently,  even  "getting  together 
to  discuss  this  miserable  situation" 
can  be  considered  criminal  con- 
spiracy in  violation  of  federal  anti- 
trust laws  and  any  kind  of  concerted 
action  on  the  part  of  health  care 
professionals  is  viewed  as  price 


fixing.  This  means  physicians  and 
others  have  very  little  ability  to 
bargain  effectively  with  large  health 
care  organizations,  insurance 
companies  and  third  party  payors. 

Now  the  Ninth  Federal  Circuit 
Court  of  Appeals  has  recognized  this 
imbalance  and,  in  an  opinion  issued 
in  the  case  of  the  dentists,  has 
opened  the  door  for  more  collective 
action  on  the  part  of  physicians. 
According  to  the  court,  "individual 
health  care  providers  are  entitled  to 
take  some  joint  action  (short  of  price 
fixing  or  a group  boycott)  to  level  the 
bargaining  imbalance  created  by  the 
Plans  and  provide  meaningful  input 
into  the  setting  of  the  fee  schedules." 

Actions  that  would  not  constitute 
price  fixing,  according  to  the  court, 
would  include,  "commiserating  over 
the  low  fee  schedules;  or  impugning 
the  motivations  of  the  Plans;  even 
sabre-rattling  about  economic 
regtribution  at  some  indefinite  time 
in  the  future  if  their  grievances 
remain  unaddressed.  Some  such 
activity,  like  clamoring  for  govern- 
mental protection  of  their  interests, 
vis-a-vis  their  antagonists  or  competi- 
tors, would  even  be  constitutionally 
protected." 

This  case  may  signal  an  opening 
of  the  door  for  physicians  to  take 
collective  action  in  certain  cases 
without  violating  anti-trust  laws,  but 
it  is  only  one  court's  opinion.  Watch 
for  possible  changes  in  anti-trust 
laws  and  be  certain  to  consult  with 
an  attorney  before  undertaking  any 
collective  action  with  other  health 
care  professionals! 


Colorado  Medicine  for  January,  1993 


25 


New 


Members 


ARAPAHOE  MEDICAL  SOCIETY 

Norman  O Aarestad,  MD 
799  E Hampden  Ave  #1001 
Englewood,  CO  801 1 0 
Elected  08/1 9/92 

Judy  Baack,  MD 
5161  E Arapahoe  Rd 
Littleton,  CO  80122 
Elected  08/1 9/92 

Clifford  A Bloch,  MD 
850  E Harvard  Ave  #465 
Denver,  CO  80210 
Elected  10/01/92 

L Michelle  Booth,  MD 
7720  S Broadway  #330 
Littleton,  CO  80122 
Elected  10/20/92 

Mary  Ann  Buesing,  MD 
1 91 9 S University  Blvcl 
Denver,  CO  80210 
Elected  08/1 9/92 

Diana  M DeSantis,  MD 
7720  S Broadway  #200 
Littleton,  CO  80123 
Elected  09/1  5/92 

John  B Ebens,  MD 
799  E Hampden  Ave  #400 
Englewood,  CO  801 10 
Elected  08/1 9/92 

Edward  B Eigner,  MD 
850  E Harvard  Ave  #525 
Denver,  CO  80210 
Elected  09/1  5/92 

Hope  R Engsberg-Rauzi,  MD 
333  W Hampden  Ave  #600 
Englewood,  CO  801 10 
Elected  09/1  5/92 

Martha  C S Hepparc),  MD 
200  W Littleton  Blvd 
Littleton,  CO  80121 
Elected  09/30/92 


Charles  H Kay  Jr,  MD 
71  80  E Orchard  Rd  #202 
Englewood,  CO  801 1 1 
Elected  08/19/92 

Eric  O Kortz,  MD 
601  E Hampden  Ave  #470 
Englewood,  CO  801  1 0 
Elected  08/19/92 

Alan  S Lidsky,  MD 
799  E Hampden  Ave  #400 
Englewood,  CO  801 1 1 
Elected  08/1 9/92 

Robert  J Miner,  MD 
950  E Harvard  Ave  #660 
Denver,  CO  80210 
Elected  07/23/92 

Charlotte  D Scanlon,  MD 
6169  S Balsam  Way  #240 
Littleton,  CO  80123 
Elected  1 0/20/92 

Mitchell  D Seemann,  MD 
1 805  Kipling  St 
Lakewood,  CO  8021  5 
Elected  09/1  5/92 

AURORA-ADAMS  COUNTY 
MEDICAL  SOCIETY 

Carolyn  Burkhardt,  MD 
1601  E 19th  Ave  #4400 
Denver,  CO  80218 
Elected  10/01/92 

Michael  Charney,  MD 
4545  E 9th  Ave  #510 
Denver,  CO  80220 
Elected  08/1 1/92 

Raphael  J d'Angelo,  MD 
14991  E Hampden  Ave  #210 
Aurora,  CO  80014 
Elected  08/04/92 

Joel  P Karasek,  MD 
3483  W 101st  PI 
Westminster,  CO  80030 
Elected  09/01/92 


Thomas  P McDonough,  MD 
14991  E Hampden  Ave  #280 
Aurora,  CO  80014 
Elected  10/01/92 

Brian  D Ryals,  MD 
5206  S Flanders  St 
Aurora,  CO  80015 
Elected  10/01/92 

Jonathan  J Seidlin,  MD 
730  Potomac  St  #1  24 
Aurora,  CO  8001 1 
Elected  10/01/92 

BOULDER  COUNTY  MEDICAL 
SOCIETY 

Robert  H Levine,  MD 
2750  Broadway 
Boulder,  CO  80304 
Elected  08/01/92 

John  S O'Hearne,  MD 
90  Health  Park  Dr  #290 
Louisville,  CO  80027 
Elected  11/01/92 

Carolyn  S Schaffter,  MD 
90  Health  Pk  Dr  #300 
Louisville,  CO  80027 
Elected  08/1  2/92 

Michael  VonGortler,  MD 
4649  Apple  Way 
Boulder,  CO  80301 
Elected  08/1 2/92 

CLEAR  CREEK  VALLEY  MEDICAL 
SOCIETY 

Mark  J Conklin,  MD 
3550  Lutheran  Pkwy  West  #201 
Wheat  Ridge,  CO  80033 
Elected  09/29/92 

Patrick  S Freeman,  MD 
5730  Ward  Rd  #102 
Arvada,  CO  80002 
Elected  09/24/92 


26 


Colorado  Medicine  for  January,  1993 


James  A Hopfenbeck,  MD 
8300  W 38th  Ave 
Wheat  Ridge,  CO  80033 
Elected  09/24/92 

David  A Landy,  MD 
3329  E Bayaud  Ave  #1316 
Denver,  CO  80209 
Elected  09/1  6/92 

Lucien  T Megna,  MD 
8770  Wadsworth  Blvcl 
Arvada,  CO  80003 
Elected  08/1  3/92 

Grant  C Olson,  MD 
8074  S Quince  Way 
Englewood,  CO  801 1 2 
Elected  08/1 9/92 

Kirk  T Shamley,  MD 
8300  Alcott  St  #300 
Westminster,  CO  80030 
Elected  09/08/92 

Steve  M Volin,  MD 
8300  N Alcott  St  #300 
Westminster,  CO  80030 
Elected  09/24/92 

Carlton  L Wallis  Jr,  MD 
8300  W 38th  Ave 
Wheat  Ridge,  CO  80033 
Elected  09/24/92 

DELTA  COUNTY  MEDICAL 
SOCIETY 

Kenneth  J Eckstein,  MD 
PO  Box  10100 
Delta,  CO  81416 
Elected  09/08/92 

DENVER  MEDICAL  SOCIETY 

Bruce  E Andrea,  MD 
101  S Downing  St  #6 
Denver,  CO  80209 
Elected  12/01/92 

Tanya  S Argo,  MD 
3467  W 97th  Ave  #23 
Westminster,  CO  80030 
Elected  12/01/92 


New 


Paul  S Asmar,  MD 
9891  E Jewell  Ave 
Denver,  CO  80231 
Elected  09/04/92 

Ronald  N Baxter,  MD 
11  50  Syracuse  St  #8-145 
Denver,  CO  80220 
Elected  09/04/92 

John  N Beattie,  MD 
4640  Greenbriar  Ct 
Boulder,  CO  80303 
Elected  09/04/92 

|ohn  D Bender,  DO 
1 2061  Tejon  St 
Westminster,  CO  80234 
Elected  11/01/92 

Andrew  T Blair,  MD 
7557  E Warren  Ave  ##5-303 
Denver,  CO  80231 
Elected  12/01/92 

Rosalie  A Bondi,  DO 
6573  Benton  Cir 
Arvada,  CO  80003 
Elected  09/04/92 

Steve  Carstens,  DO 
3433  Lowell  Blvd 
Denver,  CO  8021 1 
Elected  09/04/92 

Gregory  D Denzel,  DO 
1 738  S Franklin  St 
Denver,  CO  80210 
Elected  09/04/92 

Avninder  Singh  Dhaliwal,  MD 
1 939  S Quebec  Way 
H-822 

Denver,  CO  80231 
Elected  1 2/01/92 

Eleanor  M Diss,  MD 
1601  E 19th  Ave  #6500 
Denver,  CO  80218 
Elected  08/01/92 

James  C Duke,  MD 
4200  E 9th  Ave  #B-1 13 
Denver,  CO  80262 
Elected  1 1/01/92 


Alexandra  A Fortner,  MD 
1820  Gilpin  St  #210 
Denver,  CO  80218 
Elected  12/01/92 

Gayle  A Frazzetta,  MD 
9085  E Mississippi  Ave  #M-20 7 
Denver,  CO  80231 
Elected  09/04/92 

Perry  L Haney,  MD 
PO  Box  24344 
Denver,  CO  80224 
Elected  09/04/92 

Karen  Faye  Higgins,  MD 
4200  E 9th  Ave 
Box  270-C 
Denver,  CO  80262 
Elected  12/01/92 

Karen  L Hord,  MD 
645  Bannock  St 
Denver,  CO  80204 
Elected  12/01/92 

Ronnie  S Horowitz,  MD 
645  Bannock  St 
Denver,  CO  80204 
Elected  08/01/92 

Elizabeth  L Horvath,  DO 
1 357  Williams  St  #305 
Denver,  CO  80218 
Elected  09/04/92 

Annie  Y Johnson,  DO 
1250  S Kline  Way 
Lakewood,  CO  80226 
Elected  09/04/92 

Timothy  B Judd,  DO 
1801  E Girard  PI  #247 
Englewood,  CO  801 1 0 
Elected  09/04/92 

Corby  S Kessler,  MD 
900  Potomac  St 
Aurora,  CO  8001 1 
Elected  09/01/92 

Robert  E Khoo,  MD 
4500  E 9th  Ave  #340 
Denver,  CO  80220 
Elected  12/01/92 


Colorado  Medicine  for  January,  1993 


27 


New  Members 


Anita  J Klaus,  MD 
7359-B  W Kentucky  Dr 
Lakewood,  CO  80226 
Elected  09/04/92 

Douglas  A Milligan,  MD 
4500  E 9th  Ave  #220-S 
Denver,  CO  80220 
Elected  07/28/92 

Steven  C Posson,  DO 
4923  S Carson  St  #1  -1 03 
Aurora,  CO  80015 
Elected  09/04/92 

James  D Kriseman,  DO 
480  S Joplin  St  #2-102 
Aurora,  CO  80017 
Elected  12/01/92 

Thomas  D Mino,  DO 
3655  S Verbena  St  #C-202 
Denver,  CO  80237 
Elected  09/04/92 

Cynthia  M Ruggero,  MD 
653  Marion  St 
Denver,  CO  80218 
Elected  08/01/92 

Laurie  M Vande  Krol,  MD 
3032  S King  St 
Denver,  CO  80236 
Elected  08/01/92 

Judy  M Mouchawar,  MD 
4860  Meredith  Way  #1  30 
Boulder,  CO  80303 
Elected  09/04/92 

Susan  L Sant i 1 1 i , MD 
500  W 123rd  Ave  #3332 
Westminster,  CO  80234 
Elected  10/01/92 

Frank  R Lansville,  DO 
12806  W 61st  PI 
Arvada,  CO  80004 
Elected  09/04/92 

Dilsher  Nawaz,  MD 
17033  E Greenwood  Cir 
Aurora,  CO  8001  3 
Elected  10/24/86 

John  W Schultz,  MD 
1721  E 19th  Ave  #468 
Denver,  CO  80218 
Elected  08/01/92 

Joon  Hak  E Lee,  MD 
4862  B E Kentucky  Ave 
Denver,  CO  80222 
Elected  09/04/92 

Daniel  H Nguyen,  MD 

4801  S Wadsworth  Blvd  #8-304 

Littleton,  CO  801 23 

Elected  09/04/92 

Eduardo  Seda,  MD 
1820  Gilpin  St  #210 
Denver,  CO  80218 
Elected  12/01/92 

Joseph  H Lock  Jr,  MD 
8965  E Florida  Ave  #11 -302 
Denver,  CO  80231 
Elected  1 1/01/92 

Patricia  Nolan,  MD 
4300  Cherry  Creek  Dr  S 
Denver,  CO  80222 
Elected  0 

Andrew  A Shultz,  MD 
1 5068  E Mexico  Dr 
Aurora,  CO  80012 
Elected  12/01/92 

Elizabeth  A Loudon,  MD 
1 1 1 1 Ash  St  #704 
Denver,  CO  80220 
Elected  08/01/92 

Norman  | Novel ly,  DO 
1601  E 19th  Ave  #5500 
Denver,  CO  80218 
Elected  1 1/01/92 

John  L Smith,  MD 
1601  E 19th  Ave  #5200 
Denver,  CO  80218 
Elected  08/01/92 

Liesel  E A Lowell,  MD 
991 1 E Colorado  Ave  #624 
Denver,  CO  80231 
Elected  09/04/92 

Calvin  J Okey,  DO 
12150  Race  St  #L-201 
Northglenn,  CO  80241 
Elected  09/04/92 

Michael  D Smith,  MD 
1 001  E Bayaud  Ave  #1 007 
Denver,  CO  80205 
Elected  09/01/92 

Dale  F Mabe,  DO 
51  5 Lost  Angel  Rd 
Boulder,  CO  80302 
Elected  09/04/92 

Rebekah  K Owen,  MD 
1 470  S Quebec  Way  #1  74 
Denver,  CO  80231 
Elected  10/01/92 

Arthur  R Snyder,  MD 
360  S Garfield  St  #630 
Denver,  CO  80209 
Elected  12/01/92 

Nola  A MacDonald,  DO 
3100  Cherry  Creek  Dr  S #202 
Denver,  CO  80209 
Elected  09/04/92 

Andrew  W Parker,  MD 
4500  E 9th  Ave  #450S 
Denver,  CO  80220 
Elected  10/01/92 

Glen  N Villanueva,  DO 
817  27th  St 
Denver,  CO  80205 
Elected  1 1/01/92 

Andrew  J Michael,  MD 
850  E Harvard  Ave 
Denver,  CO  80210 
Elected  10/01/92 

John  G Petty,  MD 
1616  Olive  St 
Denver,  CO  80220 
Elected  09/04/92 

Anna  M Wegleitner,  MD 
2020  S Oneida  St  #100 
Denver,  CO  80224 
Elected  10/01/92 

28 


Colorado  Medicine  tor  January,  1993 


Lawrence  S Wilner,  DO 
601  E 19th  Ave 
Denver,  CO  80203 
Elected  09/04/92 

Sandra  L Wootton,  MD 
1056  E 19th  Ave 
Dept  of  Rad 
Denver,  CO  80218 
Elected  09/01/92 

EL  PASO  COUNTY  MEDICAL 
SOCIETY 

Peter  E Anderson,  MD 
825  E Pikes  Peak  Ave 
Colorado  Springs,  CO  80903 
Elected  09/08/92 

Laurence  J Cohen,  DO 
2835  Hunters  Glenn  Rd 
Monument,  CO  801 32 
Elected  09/08/92 

Brian  Cole,  MD 
1901  N Union  Blvd  #102 
Colorado  Springs,  CO  80909 
Elected  10/07/92 

Richard  E Collister,  MD 
1 660  Stoney  Point  Ct 
Colorado  Springs,  CO  80919 
Elected  09/08/92 

Matthew  M Cooper,  MD 
1 725  E Boulder  St  #104 
Colorado  Springs,  CO  80909 
Elected  09/09/92 

Robert  L Fritz,  MD 
209  S Nevada  Ave 
Colorado  Springs,  CO  80903 
Elected  1 1/18/92 

Mitchell  L Goldblum,  MD 
325  Parkside  Dr 
Colorado  Springs,  CO  80910 
Elected  10/21/92 

Susan  M McMaster,  DO 
4760  Flintridge  Dr  #200 
Colorado  Springs,  CO  8091  8 
Elected  09/08/92 


New 


Joseph  M Pruitt,  MD 
3205  N Academy  Blvd 
Colorado  Springs,  CO  8091  7 
Elected  1 1/18/92 

Dennis  C Raphael,  MD 
2131  N Tejon  St  #L-2 
Colorado  Springs,  CO  80907 
Elected  09/01/82 

Pamela  K Richards,  MD 
1725  E Boulder  St  #201 
Colorado  Springs,  CO  80909 
Elected  09/09/92 

David  W Ross,  DO 
825  E Pikes  Peak  Ave 
Colorado  Springs,  CO  80903 
Elected  09/23/92 

Steven  E Ryan,  MD 
7750  N Union  Blvd 
Colorado  Springs,  CO  80920 
Elected  09/09/92 

Patrick  W Schmitt,  DO 
2233  Academy  PI  #200 
Colorado  Springs,  CO  80909 
Elected  09/09/92 

John  L Sherman,  MD 
21 1 5 E LaSalle  St 
Colorado  Springs,  CO  80909 
Elected  08/1  3/92 

Jon  F Snider,  MD 
1465  N Union  Blvd  #200 
Colorado  Springs,  CO  80909 
Elected  1 1/18/92 

Terri  B Weber,  MD 
7608  N Union  Blvd  #E 
Colorado  Springs,  CO  80920 
Elected  09/08/92 

Robert  A Whiteford,  DO 
31 1 N Union  Blvd 
Colorado  Springs,  CO  80909 
Elected  1 1/18/92 

INTERMOUNTAIN  MEDICAL 
SOCIETY 


Patricia  A Duletsky,  MD 
1 01  W Main  St 
PO  Box  653 
Frisco,  CO  80443 
Elected  09/1  3/92 

LARIMER  COUNTY  MEDICAL 
SOCIETY 

Kendrick  M Adnan,  MD 
1 500  S Lemay  Ave 
Fort  Collins,  CO  80524 
Elected  07/1  5/92 

Douglas  W Beard,  MD 
2500  E Prospect  Ave 
Fort  Collins,  CO  80525 
Elected  07/1 5/92 

Hans  C Coester,  MD 
1313  Riverside  Ave 
Fort  Collins,  CO  80524 
Elected  07/1 5/92 

Winfield  M Craven,  MD 
1 024  S Lemay  Ave 
Fort  Collins,  CO  80524 
Elected  07/1  5/92 

Gary  M Garner,  MD 
1 500  S Lemay  Ave 
Fort  Collins,  CO  80524 
Elected  07/1 5/92 

Mark  W Hoenig,  MD 
1 500  S Lemay  Ave 
Fort  Collins,  CO  80524 
Elected  07/1 5/92 

Stephen  G Horne,  MD 
1 024  Lemay  Ave 
Fort  Collins,  CO  80524 
Elected  07/1 5/92 

Christina  L Kuroiwa,  MD 
1 500  S Lemay  Ave 
Fort  Collins,  CO  80524 
Elected  07/1  5/92 

Harvey  J Navrkal,  MD 
1 500  S Lemay  Ave 
Fort  Collins,  CO  80524 
Elected  07/1 5/92 


Colorado  Medicine  for  January,  1993 


29 


Tim  P Podhajsky,  MD 
1 500  S Lemay  Ave 
Fort  Collins,  CO  80524 
Elected  07/1  5/92 

Matthew  J Robinson,  MD 
1017  Robertson  St 
Fort  Collins,  CO  80524 
Elected  07/1  5/92 

Robert  L Sancetta,  MD 
1 500  S Lemay  Ave 
Fort  Collins,  CO  80524 
Elected  07/1 5/92 

Norma  J Stiglich,  MD 
1 224  E Elizabeth  St 
Fort  Collins,  CO  80524 
Elected  07/1  5/92 

MEDICAL  STUDENT  COMPONENT 
MEDICAL  SOCIETY 

Mary  L Bowman 
7536  E Warren  Dr  #1  5-305 
Denver,  CO  80231 
Elected  08/1 5/92 

Craig  L Brown 
61 1 Harrison  St 
Denver,  CO  80206 
Elected  09/02/92 

Lesli  S DeBord 
880  Dexter  St  #204 
Denver,  CO  80220 
Elected  09/02/92 

Sam  Ferszt 
2246  S Corona  St 
Denver,  CO  80210 
Elected  08/24/92 

Angela  R Hahn 
1 01 1 Milwaukee  St 
Denver,  CO  80206 
Elected  09/02/92 

Anne  E Harper 
889  Eudora  St 
Denver,  CO  80220 
Elected  08/24/92 


30 


Christine  Hopper 

Nick  Slenkovich 

6491  Barnacle  Ct 

4225  E 7th  Ave 

Boulder,  CO  80301 

Denver,  CO  80220 

Elected  08/1  5/92 

Elected  10/24/92 

David  L Kirschman 

Peter  N Toensing 

1175  Albion  St  #410 

860  Clermont  St  #503 

Denver,  CO  80220 

Denver,  CO  80220 

Elected  08/24/92 

Elected  1 0/24/92 

Lillian  Klancar 

Judith  D R Wilson 

476  S Logan  St 

PO  Box  3912 

Denver,  CO  80209 

Littleton,  CO  801  61 

Elected  09/23/92 

Elected  08/24/92 

Sarah  Leisenring 
860  Clermont  St  #603 

MESA  COUNTY  MEDICAL  SOCIETY 

Denver,  CO  80220 

Sigma  Alpha,  MD 

Elected  09/23/92 

1 1 20  Wellington  Ave  #206 
Grand  Junction,  CO  81501 

Saurabh  Mangalik 
1 260  Ivanhoe  St 

Elected  11/03/92 

Denver,  CO  80220 

Michael  E Holt,  MD 

Elected  10/09/92 

2530  N 8th  St  #101 
Grand  Junction,  CO  81501 

Abilio  Munoz 
955  Harrison  St 

Elected  1 0/06/92 

Denver,  CO  80206 

Daniel  P Sullivan,  MD 

Elected  08/24/92 

729  Bookcliff  Ave 
Grand  lunction,  CO  81501 

Jenny  Riggs 
794  Cherry  St 

Elected  11/03/92 

Denver,  CO  80220 

MORGAN  COUNTY  MEDICAL 

Elected  09/02/92 

SOCIETY 

lennifer  A Roller 

860  Clermont  St  #602 

Andrew  John  Saueracker,  MD 

Denver,  CO  80220 

625  W Platte 

Elected  08/24/92 

Fort  Morgan,  CO  80701 
Elected  10/09/92 

lason  Roth 

61 1 Harrison  St 

Robert  A Thiel,  MD 

Denver,  CO  80206 

102  W 9th  Ave 

Elected  09/23/92 

Fort  Morgan,  CO  80701 
Elected  10/21/92 

William  Rumace 

61 1 Harrison  St 

MT.  SOPRIS  COUNTY  MEDICAL 

Denver,  CO  80206 
Elected  09/23/92 

SOCIETY 

Matthew  L Goodstein,  MD 

Kimberly  M Simons 

1905  Blake  Ave  #201 

1175  Albion  St  #104 

Glenwood  Springs,  CO  81601 

Denver,  CO  80220 
Elected  08/24/92 

Elected  07/1  5/92 

Colorado  Medicine  for  January,  1993 


N ew  Members/I  n 


Kimball  | Spence,  DO 
1340  Hwy  133 
Carbondale,  CO  81623 
Elected  07/1  5/92 

NORTHEAST  COLORADO 
MEDICAL  SOCIETY 

Joseph  E Bonelli,  MD 
61  5 Fairhurst 
Sterling,  CO  80751 
Elected  09/1  5/92 

PUEBLO  COUNTY  MEDICAL 
SOCIETY 

Isabel  Bertran,  MD 
1008  Minnequa  Ave 
Pueblo,  CO  81004 
Elected  10/13/92 

Thomas  W Dorrell,  MD 
1 008  Minnequa  Ave 
Pueblo,  CO  81004 
Elected  1 0/1  3/92 

Imran  U Khan,  MD 
1 925  E Orman  Ave  #G-1 2 
Pueblo,  CO  81004 
Elected  09/1 6/92 

John  | Kunstle,  MD 
1008  Minnequa  Ave 
Pueblo,  CO  81004 
Elected  10/13/92 

David  M Oba,  MD 
1 9 Fordham  Cir 
Pueblo,  CO  81005 
Elected  08/11/92 

Craig  J Panos,  MD 
1008  Minnequa  Ave 
Pueblo,  CO  81004 
Elected  10/13/92 

Jennifer  A Pentecost,  MD 
1008  Minnequa  Ave 
Pueblo,  CO  81004 
Elected  1 2/07/92 

Joni  K Salmon,  MD 
1008  Minnequa  Ave 
Pueblo,  CO  81004 
Elected  1 0/1  3/92 


In  Memory 


Osmyn  W.  McFarland  MD.  died  on  April  22,  1991. 
Ernest  Wittenberg,  MD.  died  in  April  of  1 991 . 

Clarence  L.  Ross,  MD.  died  on  June  23,  1991. 

Ann  Thron,  MD.  died  on  July  30,  1 991 . 

Frank  L.  Garner,  MD.  died  in  August  of  1991. 

Rollin  L.  Thompson,  MD.  died  September  9,  1991 
James  Robert  Blair,  MD.  died  on  September  13,  1991. 
Dorothy  C. Campbell,  MD.  died  in  October  of  1991. 
Robert  W.  Sherwood,  MD.  died  on  October  3,  1991. 
Thomas  K.  Kobayashi,  MD.  died  on  October  5,  1991. 

J.  Harvey  Johnston,  MD.  died  on  October  12,  1991. 
William  L.  Halseth,  MD.  died  on  October  28,  1991. 
Wallace  H.  Livingston,  MD.  died  on  November  1,  1991. 
John  Douglas  Carson,  MD.died  on  November  7,  1991. 
John  Kanas,  MD.  died  on  November  1 1,  1991 
William  L Waldrop,  MD.  died  on  November  28,1  991 
Roscoe  Hope  Ackerly,  MD.  died  on  December  4,  1991. 
Harvey  S.  Rusk,  MD.  died  on  December  6,  1991. 
Rodney  H.  Jones,  MD.  died  on  December  16,  1991 
Mark  L Apling,  MD.  died  on  December  21 , 1991. 

Ernest  Forman,  MD.  died  on  January  4,1992. 

Jearl  F.  Frye,  MD.  died  on  February  22,  1992. 

Vincent  A.  Lagerborg,  MD.  died  on  July  7,  1 992. 

James  D.  Stewart,  MD.  died. 

James  M.  Myers  MD.  died  on  March  4,  1992. 

Gary  H.  Fletcher,  MD.  died  in  March  7,  1992. 

William  Martin  MD.  died  on  April  27,  1992. 

Leonard  W.  Levisohn  died  in  April  of  1992. 

Ruth  B.  Howard,  MD.  died  on  May  1,  1992. 

Robert  Chandler,  MD.  died  May  8,  I 992. 

Raymond  H.  Smith  , MD.  died  on  June  13,  1992. 
Demosthenes  A.  Manolis,  MD.  died  on  June  23,  1 992. 
Vincent  A.  Lagerborg,  MD.  died  on  July  7,  1992. 

Isamu  Ozamoto,MD.  died  on  December  28,  1992. 


Colorado  Medicine  for  January,  1993 


31 


New  Officers 


ARAPAHOE  MEDICAL  SOCIETY 
TERM  EXPIRES  4/93 

PRESIDENT 

Robert  L.  Kurse,  M.D. 

501  E.  Hampden  Avenue 
Englewood,  Colorado  801 1 0 
761-5325 
PRESIDENT-ELECT 
Janice  Benneman,  M.D. 

3333  S.  Bannock  StreetEnglewood, 

Colorado  801 1 0 

No  phone  listed 

TREASURER 

Arthur  P.  Heller,  M.  D. 

601  East  Hampden  Avenue 
Englewood,  Colorado  801 10 
778-6446 

ASSOCIATE  DIRECTOR 

Anne  Wooley 

777  East  Girard  Avenue 

Englewood,  Colorado  801  10 

761-2887 

SECRETARY 

Robert  j.  Gillesby,  M.D. 

701  E.  Hampden  Ave. 

Englewood,  Colorado  801 10 
788-4250 

BOULDER  COUNTY  MEDICAL 
SOCIETY  TERM  EXPIRES  10/93 

PRESIDENT 

Kevin  R.  Berg,  M.D. 

1925  W.  Mountain  View  Avenue 
Longmont,  Colorado  80501 
776-1234 

PRESIDENT-ELECT 

None  elected 
EXECUTIVE  DIRECTOR 

Joan  Ladley 
6560  Gunpark  Drive 
Boulder,  Colorado  80301 
530-3635 

SECRETARY/TREASURER 

Alan  E.  Benson,  M.D. 

1950  W.  Mountain  View  Avenue 
P.O.  Box  1659 
Longmont,  Colorado  80501 
651-5085 

CHAFFEE  COUNTY  MEDICAL  SOCIETY 
TERM  EXPIRES  4/93 

PRESIDENT 

Donald  W.  Cline,  M.D. 

P.O.  Box  3129 

Buena  Vista,  Colorado  81211 

719-395-8632 


Because  this  information  is  supplied  by  the  component  societies,  we  are  not 
responsible  for  its  timeliness  or  accuracy. 


CLEAR  CREEK  VALLEY  MEDICAL 
SOCIETY 

TERM  EXPIRES  10/93 

PRESIDENT 

Howard  E.  Netz,  M.;D. 

801 5 West  Alameda  Avenue 
Lakewood,  Colorado  80226 
232-8383 
PRESIDENT-ELECT 
Harold  A.  Yocum,  M.D. 

4200  West  Conejos  Place 
Denver,  Colorado  80204 
893-2228 
VICE  PRESIDENT 
Harold  A.  Yocum,  M.D. 

4200  West  Conejos  Place 
Denver,  Colorado  80204 
893-2228 

EXECUTIVE  DIRECTOR 

Rene  Hawthorne-Shriver 
7536  West  1 7th  Avenue 
Lakewood,  Colorado  8021  5 
232-1428 

SECRETARY/TREASURER 

John  A.  Santoro  Jr.,  M.D. 

10001  Washington  Street 
Thornton,  Colorado  80229 
252-9981 

CURECANTI  MEDICAL  SOCIETY 
TERM  EXPIRES  12/92 

PRESIDENT 

Paul  D.  Wiesner,  M.D. 

231  South  Nevada  Avenue 
Montrose,  Colorado  81401 
249-1210 

VICE-PRESIDENT 

Jay  W.  McMurren,  M.D. 

Box  1 849 

Gunnison,  Colorado  81230 
641-021 1 

SECRETARY/TREASURER 

Lynwood  M.  Hopple,  M.D. 

3 Columbia  Way 
Montrose,  Colorado  81401 
249-2205 

EXECUTIVE  SECRETARY 

Kathy  Holman 
61120  Vernal  Road 
Montrose,  Colorado  81401 
249-221 1 x397 


DELTA  COUNTY  MEDICAL  SOCIETY 
TERM  EXPIRES  1/93 

PRESIDENT 

Jerry  S.  Driessner,  M.D. 

100  Stafford  Lane 
Delta,  Colorado  81416 
874-7681  x284 
VICE-PRESIDENT 
Doug  K.  Speedie,  M.D. 

70  Stafford  Lane 
Delta,  Colorado  8141  6 
874-7681 

SECRETARY/TREASURER 

Patrick  W.  Donahue,  M.D. 2 
555  Meeker  Street 
Delta,  Colorado  8141  6 
No  phone  listed 
EXECUTIVE  SECRETARY 
Fran  Cranor 
1 00  Stafford  Lane 
Delta,  Colorado  81416 
874-7681  x281 

DENVER  MEDICAL  SOCIETY 
TERM  EXPIRES  10/92 

PRESIDENT 

A.  Lee  Anneberg,  M.D. 

1901  East  20th  Avenue 
Denver,  Colorado  80205 
377-2759 
PRESIDENT-ELECT 
Terrance  J.  Sullivan  M.D. 

700  Broadway,  5th  Floor 
Denver,  Colorado  80273 
831-3259 

CHAIRMAN  OF  THE  BOARD 

Wm.  Carl  Bailey,  M.D. 

1 950  Ogden  Street 
Denver,  Colorado  8021  8 
861-4871 

EXECUTIVE  DIRECTOR 

Kathy  Lindqu ist-Kleissler 

1 850  Williams  Street 

Denver,  Colorado  80218 

377-1850 

TREASURER 

Barbara  R.  Reed,  M.D. 

2200  East  1 8th  Avenue 
Denver,  Colorado  80206 
322-7789 


32 


Colorado  Medicine  for  January,  1993 


EASTERN  COLORADO  MEDICAL 
SOCIETY 

TERM  EXPIRES  9/92 

PRESIDENT 

Jerome  L.  Keefe,  M.D. 

Box  98 

Cheyenne  Wells,  Colorado  80810 

719-767-5669 

SECRETARY 

Mark  R.  Olson,  M.D. 

1612  6th  Street 
Linton,  Colorado  80828 
719-775-2367 

EL  PASO  COUNTY  MEDICAL  SOCIETY 
TERM  EXPIRES  9/93 

PRESIDENT 

Robert  A.  Nathan,  M.D. 

2709  North  Tejon  Street 
Colorado  Springs,  Colorado  80907 
719-473-0872 
PRESIDENT-ELECT 
Marilyn  J.  Gifford,  M.D. 

1400  East  Boulder  Street 
Emergency  Dept  Memorial  Hospital 
Colorado  Springs,  Colorado  80909 
719-471-2311 
VICE  PRESIDENT 
Paul  M.  Wall,  M.D. 

2131  North  Tejon  Street 

Colorado  Springs,  Colorado  80907 

719-636-3701 

SECRETARY 

Frank  J.  Barry,  M.D. 

21  30  Hollowbrook  Drive 

Colorado  Springs,  Colorado  80918 

719-590-7007 

TREASURER 

Laura  L.  Feldman,  D.O. 

730  W.  Cheyenne  Blvd 
Colorado  Springs,  Colorado  80906 
7 19-632-0324 

ADMINISTRATIVE  DIRECTOR 

Carol  Walker 

2760  N.  Academy  Blvd. 

Colorado  Springs,  Colorado  80907 
719-591-2424 

FREMONT  COUNTY  MEDICAL 
SOCIETY 

TERM  EXPIRES  6/93 

PRESIDENT 

Gary  A.  Mohr,  M.D. 

730  Macon  Avenue 

Canon  City,  Colorado  81212 

719-275-1618 


New 


Offi 


VICE-PRESIDENT 

Eric  Carlson,  M.D. 3 

61 6 Yale  Place 

Canon  City,  Colorado  81212 

719-275-2301 

SECRETARY 

Helen  M.  Danahey,  M.D. 

1 335  Phay  Avenue 

Canon  city,  Colorado  81212 

719-269-1727 

LAKE  COUNTY  MEDICAL  SOCIETY 
TERM  EXPIRES  12/92 

PRESIDENT 

Wayne  Callen,  M.D. 

825  West  Sixth  Street 
Leadville,  Colorado  80461 
719-486-1264 
PRESIDENT-ELECT 
John  Perna,  M.D. 

825  West  Sixth  Street 
Leadville,  Colorado  80461 
719-486-1264 
SECRETARY/TREASURER 
Clifford  Field,  M.D. 

825  West  Sixth  Street 
Leadville,  Colorado  80416 
719-486-1264 

LA  PLATA  COUNTY  MEDICAL  SOCIETY 
TERM  EXPIRES  12/92 

PRESIDENT 

Mark  R.  Walters,  M.D. 

33  Lewis  Mountain  Lane 
Durango,  Colorado  81  301 
No  phone  listed. 

SECRETARY 

None  elected 

LARIMER  COUNTY  MEDICAL  SOCIETY 
TERM  EXPIRES  12/92 

PRESIDENT 

Jerry  A.  Chase,  M.D. 

1 808  Boise  Avenue 

Fort  Collins,  Colorado  80537 

669-6660 

PRESIDENT-ELECT 

William  W.  Ezell,  M.D. 

1 337  Riverside  Avenue 
Fort  Collins,  Colorado  80524 
221-9545 

SECRETARY/TREASURER 

Richard  F.  Giansiracusa,  M.D. 

1 808  Boise  Avenue 

Fort  Collins,  Colorado  80537 

669-6660 


EXECUTIVE  DIRECTOR 

Tammy  Nelson 
1 024  Lemay  Avenue 
Fort  Collins,  Colorado  80524 
490-4105 

LAS  ANIMAS  COUNTY  MEDICAL 
SOCIETY 

TERM  EXPIRES  12/92 
PRESIDENT 

Joseph  P.  Jimenez,  M.D. 

410  Benedicta,  Suite  A 
Trinidad,  Colorado  81082-2005 
719-846-2206 

VICE-PRESIDENT 

Donald  P.  Ferrell,  M.D. 

P.O.  Box  930 
Trinidad,  Colorado  81082 

SECRETARY 

Guilebaldo  E.  Jimenez,  M.D. 

Box  1 42 

Trinidad,  Colorado  81082 
719-846-7787 

MESA  COUNTY  MEDICAL  SOCIETY 
TERM  EXPIRES  9/93 

PRESIDENT 

Bronwen  J.  Magraw,  M.D. 

P.O.  Box  920 
107  W.  6th  Street 
Palisade,  Colorado  81  526 
464-561 1 

PRESIDENT-ELECT 

John  H.  Dorank,  D.O. 

249  N.  Plum  Street 
Fruita,  Colorado  81  521 
858-9894 

SECRETARY/TREASURER 

Paul  B.  Jones,  M.D. 

2525  N.  8th  Street 

Grand  Junction,  Colorado  81  501 

245-1168 

EXECUTIVE  SECRETARY 

Dolores  Bennett 
1 1 20  Wellington  Avenue 
Grand  Junction,  Colorado  81501 
243-2808 

MORGAN  COUNTY  MEDICAL 
SOCIETY 

TERM  EXPIRES  9/92 

PRESIDENT 

James  A.  Miller,  M.D. 

231  Prospect  Avenue 

Fort  Morgan,  Colorado  80701 

867-4823 


Colorado  Medicine  for  January,  1993 


33 


New  Officers 


Because  this  information  is  supplied  by  the  component  societies,  we  are  not 
responsible  for  its  timeliness  or  accuracy. 


PRESIDENT-ELECT 

Kevin  V.  Lindell,  M.D. 

220  East  Beaver  Avenue 
P.O.  Box  370 

Fort  Morgan,  Colorado  80701 
SECRETARY/TREASURER 

Kevin  V.  Lindell,  M.D. 

220  East  Beaver  Avenue 
P.O.  Box  370 

Fort  Morgan,  Colorado  80701 

MOUNT  EVANS  MEDICAL  SOCIETY 
TERM  EXPIRES  5/93 

PRESIDENT 

Rik  Santaguida,  M.D. 

P.O.  Box  1930 

Idaho  Springs,  Colorado  80452 
567-4316 
VICE-PRESIDENT 
John  P.  Moyer,  M.D. 

P.O.  Box  2530 

Evergreen,  Colorado  80439 

674-6671 

SECRETARY/TREASURER 

Fred  Buchwald,  M.D. 

29029  Upper  Bear  Creek  Road 
Evergreen,  Colorado  80439 
674-3370 

MOUNT  SOPRIS  COUNTY  MEDICAL 
SOCIETY 

TERM  EXPIRES  12/92 

PRESIDENT 

Mark  S.  Lea,  M.D. 

401  23  rd  Street 

Glenwood  Springs,  Colorado  81  601 

No  phone  listed 

EXECUTIVE  SECRETARY 

Dolores  Bennett 

1 1 20  Wellington 

Grand  Junction,  Colorado  81  501 

243-2808 

SECRETARY/TREASURER 

Teresa  L.  Platt,  M.D. 

1 905  Blake  Avenue 

Glenwood  Springs,  Colorado  81601 

945-0554 

NORTHEAST  COLORADO  MEDICAL 
SOCIETY 

TERM  EXPIRES  5/93 

PRESIDENT 

Richard  C.  Lamb,  M.D. 

620  Iris  Drive 

Sterling,  Colorado  80751 

522-7266 


STAFF  SUPPORT  (CONTACT  FIRST) 

LaVonne  Bilyeu 
Plains  Radiology 
1430  South  7th  Avenue 
Sterling,  Colorado  80751 
522-6386 
SECRETARY 

Thomas  M.  Pickard,  M.D. 

507  Pawnee  Drive,  Rt  4 
Sterling,  Colorado  80751 
522-5610  (unlisted) 

NORTHWESTERN  COLORADO 
MEDICAL  SOCIETY 
TERM  EXPIRES  9/93 

PRESIDENT 

Laura  E.  Rathe,  M.D. 2 
785  Russel  Street 
Craig,  Colorado  81625 
824-3556 

SECRETARY 

None  elected 

OTERO  COUNTY  MEDICAL  SOCIETY 
TERM  EXPIRES  9/93 

PRESIDENT 

Jeffrey  Morse,  M.D. 

245  Vine  Avenue 

Las  Animas,  Colorado  81054 

(719)  456-1243 

SECRETARY 

Howard  E.  Stutzman,  M.D. 

2201  San  Juan  Avenue 
La  Junta,  Colorado  81050 
(719)  384-8181 
Attn:  Martha  Vasquez 

PUEBLO  COUNTY  MEDICAL  SOCIETY 
TERM  EXPIRES  11/93 

PRESIDENT 

Jarvis  D.  Ryals,  M.D. 

400  West  1 7th  Street 
Pueblo,  Colorado  81 003 
719-543-4040 
PRESIDENT-ELECT 
Charles  E.  Snyder,  M.D. 

371  5 Thatcher  Avenue 

Pueblo,  Colorado  81005 

719-561-8480 

SECRETARY 

Roger  W.  Miller,  M.D. 

1 925  East  Orman  Avenue 
Pueblo,  Colorado  81004 
719-561-0383 


EXECUTIVE  SECRETARY 

Peggy  Fogel 

1 925  East  Orman  Avenue 
Pueblo,  Colorado  81004 
719-564-9109  (office) 

719-542-01 06  (answering  service) 

TREASURER 

Christopher ).  Smith,  M.D. 

51  7 Colorado  Avenue 
Pueblo,  Colorado  81004 
719-543-4016 

SAN  LUIS  VALLEY  MEDICAL  SOCIETY 
TERM  EXPIRES  12/92 

PRESIDENT 

Phillip  J.  Bogner,  M.D. 

17228  W.  Highway  160 
Del  Norte,  Colorado  81 132 
719-657-3342 
VICE-PRESIDENT 
Grant  Allen  Hurley  Jr,  M.D. 

404  Morris  Street 

Monte  Vista,  Colorado  81 1 44 

719-852-4073 

SECRETARY/TREASURER 

Lonnie  S.  Vickers,  M.D. 

1 7228  W.  Highway  1 60 
Del  Norte,  Colorado  81 1 32 
719-657-3342 

SOUTHEASTERN  COLORADO 
MEDICAL  SOCIETY 
TERM  EXPIRES  10/92 

PRESIDENT 

Donald  F.  Benton,  M.D. 

200  Kendall  Drive 
Lamar,  Colorado  81052 
719-336-9068 
VICE-PRESIDENT 
Ousama  Ghaibeh,  M.D. 

P.O.  Box  1 1 72 
Lamar,  Colorado  81052 
719-336-2798 
SECRETARY 
Michael  J.  Lee,  M.D. 

200  Kendall  Drive 
Lamar,  Colorado  81052 
719-336-3247 

UCMC  STUDENT  MEDICAL  SOCIETY 
TERM  EXPIRES  9/93 

PRESIDENT 

Anthony  Nagorka 
753  1/2  Ash  Street 
Denver,  Colorado  80220 
399-4686 


34 


Colorado  Medicine  for  January,  1993 


New  Officers 


VICE-PRESIDENT 

Paul  D.  Bonacci 

955  Eudora  Street 

Denver,  Colorado  80220 

388-3852 

SECRETARY 

Theresa  Scholz 

6039  Wright  Street 

Arvada,  Colorado  80004 

No  phone  listed 

TREASURER 

Kelli  Lambert 

9085  E.  Mississippi  Ave 

Denver,  Colorado  80231 

No  phone  listed 

WASHINGTON-YUMA  COUNTY 
MEDICAL  SOCIETY 
TERM  EXPIRES  12/92 

PRESIDENT 

Robert  D.  Buchanan,  M.D. 

Wray  Clinic 

P.O.  Box  216 

Wray,  Colorado  80758 

322-4895 

SECRETARY 

Robert  G.  Loyd,  M.D. 

Wray  Clinic 
P.O.  Box  216 
Wray,  Colorado  80758 
332-4895 

WELD  COUNTY  MEDICAL  SOCIETY 
TERM  EXPIRES  9/94 


“I  have  never  gotten  used 
to  people  dying.  And  I don’t 
want  to  get  used  to  it.” 

Dr.  Aliza  Lifshitz,  Internist,  Los  Angeles,  California, 

Member,  American  Medical  Association 


PRESIDENT 

lames  H.  Peterson,  M.D. 

2528  16th  Street 
Greeley,  Colorado  80631 
356-4646 
PRESIDENT-ELECT 
Robert  C.  Bradley,  M.D. 

1 230  West  Ash  Street 
Windsor,  Colorado  80550 
686-5646 

TREASURER/SECRETARY 

Jeffrey  B.  Weeks,  M.D. 

3400  1 6th  Streeteeley,  Colorado 
356-4040 

EXECUTIVE  SECRETARY 

Pennie  Joseph 

North  Colorado  Medical  Center 
1801  1 6th  Street 
Greeley,  Colorado  80631 
353-2596 


Patients  come  to  physicians  for  many  reasons. 
Beyond  relief  from  pain,  they  seek  compassion,  empa- 
thy and  support,.  AIDS  patients  receive  all  of  these  and 
more  from  Dr.  Aliza  Lifshitz. 

Bom  and  raised  in  Mexico  and  educated  at  one  of 
Mexico  City’s  finest  medical  schools,  Dr.  Lifshitz  now 
serves  the  Hispanic  community  in  Southern  California. 
Over  a third  of  her  patients  have  tested  HIV  positive. 

Most  live  below  the  poverty  level.  Many  are  illegal  aliens. 

“I  never  forget  what  it  means  to  be  a doctor,  and  what 
it  means  is  embodied  in  the  Principles  of  Medical  Ethics 
of  the  American  Medical  Association  (AMA),”  states  Dr. 
Lifshitz. 

You  are  invited  to  join  Dr.  Lifshitz  and  to  join  with  her 
in  her  efforts  to  bring  quality  health  care  to  those  in 
need.  Become  a member  of  the  AMA  today. 

Members  of  the  AMA  are  encouraged  to  join  their  state,  county  and  specialty  societies. 


American  Medical  Association 

Physicians  dedicated  to  the  health  of  America 


Colorado  Medicine  for  January,  1993 


35 


Classified  Advertising 


Publication  of  any  advertisement  in  Colorado  Medicine  is  not  an  endorsement  by  the  Colorado  Medical  Society 
of  the  product  or  service.  Colorado  Medicine  magazine  is  the  official  journal  of  the  Colorado  Medical  Society,  and 
is  authorized  to  carry  General  Advertising. 


♦ PROFESSIONAL  OPPORTUNITIES 

BC/BE  DIAGNOSTIC  RADIOLOGY— 
Immediate  opening  for  Diagnostic  Radi- 
ologist with  skills  in  MRI  & Interventional. 
Join  a growing  3-4  physician  practice  in 
1 00  bed  community  hospital  45  miles  north 
of  Denver.  Attractive  compensation 
package  with  track  to  partnership.  Send  CV 
to  Donald  Cornforth,  MD,  PO  Box  238, 
Loveland,  CO  80539  or  contact  Sharon  at 
(303)669-7916.  4/1192 

GENERAL  SURGEON  needed  to  join 
compatible  staff,  small  VA  medical  center 
in  Cheyenne,  WY.  Laparoscopic,  vascular/ 
thoracic  surgery  beneficial.  Competitive 
salary/benefits.  Ideal  location  with  varied 
recreational  activities  — hunting,  fishing, 
skiing  and  campint.  2 hrs  from  Denver 
CME  opportunities,  theater,  arts  and 
professional  sports.  Affiliation  with  U of 
Colorado  possible.  Local  community 
college.  U of  Wyoming  only  1 hr  away. 
Excellent  public  education  system,  low 
crime,  low  cost  living  — no  state  income 
tax.  Send  CV/resume  to  Mike  Lee  (11  A), 
VA  Medical  Center,  2360  E Pershing  Blvd, 
Cheyenne  WY  82001,  or  call  (307)  778- 
7307.  4/1192 

LOCUM  TENENS  COVERAGE  and  Op- 
portunities in  the  greater  Denver  area: 
CompHealth,  the  nation's  premier  locum 
tenens  organization,  now  provides  daily, 
weekly,  weekend,  evening,  or  monthly 
coverage  for  your  practice  with  physicians 
from  the  local  area.  Or  we  offer  you  the 
opportunity  to  build  a flexible  practice 
right  in  the  Denver  area.  Call  today  for 
more  information,  (303)  777-8002,  or  write, 
P.O.  Box  1 00218,  Denver  CO  80250.1  2/ 
1092 

EMERGENT/URGENT  CARE  PHYSICIAN 
Full  and  part  time  position  in  Lafayette. 
Flexible  scheduling.  Send  CV  or  Contact 
Dr.  Coryell,  Community  Medical  Center, 
2000  W.  S.  Boulder  Rd.,  Lafayette,  CO 
80206,  (303)  666-4357.  1 2/0892 


FAMILY  PRACTICE  OPPORTUNITY  IN 
CANON  CITY 

We  need  one  family  physician  to  practice 
in  the  Climate  Capital  of  Colorado. 
Privileges  at  St.  Thomas  More  Hospital, 
obstetric  services  desirable  but  not  required. 
Unlimited  opportunities  for  recreation. 
Growingcommunity.  Formore  information, 
please  call  or  write  Gary  Alan  Mohr,  MD, 
FAAFP,  730  Macon  Avenue,  Canon  City, 
CO  81212,  (719)  275-1618  Tfn/0892 

LOCUM  TENENS It  is  not  what  it  used 

to  be.  As  a client,  your  practice  goes 
uninterrupted.  As  a locum  tenens,  you  have 
the  freedom  and  flexibility  to  work  as  often 
or  as  little  as  you  like.  Physician  managed 
since  1982.  Call  for  details — Interim 
Physicians  1 -800-669-071 8 or  (303)  691  - 
0718.  12/0192 

FAMILY  PRACTICE— HOSPITAL  SPON- 
SORED  CLIN  1C  OPPORTUNITY.  Dynamic, 
growth  oriented  hospital  in  beautiful  North 
Central  Wisconsin  is  seeking  Family 
Physicians  to  respond  to  growing  com- 
munity demand.  The  administrative  burdens 
of  medical  practice  will  be  minimized  in 
this  hospital  managed  clinic.  The  hospital 
has  committed  to  an  income  and  benefit 
package  which  is  significantly  higher  than 
similar  opportunities.  Package  includes 
base  income,  incentive  bonus,  malpractice, 
disability,  signing  bonus  and  student  loan 
reduction/forgiveness  program.  All  re- 
location costs  will  be  borne  by  the  hospital. 
Please  contact  Kari  Wangsness,  Associate, 
The  Chancellor  Group,  Inc.,  France  Place, 
Suite  920,  3601  Minnesota  Drive, 
Bloomington,  Minnesota,  55435,  (612) 
835-5123.  tfn/1190 

FAMILY  PHYSICIAN  needed  full  time  to 
practice  in  great  Lakewood  location.  Duties 
includefamily  practice  medicineexcluding 
OB  and  inpatient  hospital  work.  Four 
physician  call  group.  Excellent  com- 
pensation package.  Please  contact  Shirley 
Lewis,  Porter  Hospital,  (303)  778-5691.2/ 
1292 


EXPERIENCED  ANESTHESIOLOGIST 
preparing  for  oral  board  exam  in  April 
1993.  Desires  part  time  or  low-volume 
practice  or  Locum  Tenens.  Contact  David 
Murphy,  MD.  4 Middle  Rd.  Englewood, 
CO  801 1 0.  (303)  753-1819.  3/1 292 

LOCUM  TENENS...  new  adventures,  free 
from  administrative  tasks,  flexibility,  and 
high  earnings.  Assignments  vary:  one  day, 
one  week,  one  month,  long  term,  OR,  time 
off  with  peace  of  mind,  knowing  that  your 
practice  goes  uninterrupted.  Qualified 
physicians  are  ready  to  assist.  Ten  years 
experience;  physician-managed  company. 
Call  INTERIM  PHYSICIANS  today  for 
details.  — Denver  691  -071 8,  or  1 -800-669- 
0718  12/1292 

UROLOGY  PRACTICE  OPPORTUNITY  in 
South  Central  Colorado.  Western  com- 
munity at  edge  of  Rocky  Mountains  offers 
clean  environment,  quality  of  life,  easy 
access  to  larger  communities.  Group 
Practice.  Hospital  pays  interview  and 
relocation  expenses.  Offers  financial 
support  for  selected  candidate  for  a period 
of  time.  Call  collect:  Willim  Foster,  CEO 
(719)  269-2021  or  269-9305.  2/1292 

COLORADO  MTN.  RESORT  PRACTICE 
FOR  SALE.  Busy  OB.  GYN.  practice  in  the 
ski/summer  resort  of  Steamboat  Springs. 
Available  to  BC/BE  physician.  Retiring 
physician  will  transition  practice  which 
offers  excellentfinancial  return  in  a beautiful 
mountain  community.  Good  OB.  and  GYN 
.call  coverage.  Please  send  C.V.  to  : Box  T. 
C/O  Colorado  Medical  Society,  P.O.  Box 
1 7550,  Denver,  CO.  80217-0550  3/01 93 

TIRED  OF  THE  DAY  TO  DAY  HASSLE  of 

HMO's,  Medicare,  discounted  insurance 
and  being  on  call  ? Then  consider  a position 
with  corrections.  Before  you  say  "No  Way," 
call  us  and  find  out  more.  Contact  Roderic 
Gottula,  MD,  10900  Smith  Road,  Denver 
CO  80239  or  call  (303)  375-21 1 0.6/01 93 

WANTED:  OPEN-MINDED  GENERAL 
PRACTITIONER  to  perform  evaluations  in 
multi-specialty  office.  Part  time,  flexible 
hours,  hourly  rate.  Call:  721  -7947  and  ask 
for  Dr.  K. 


36 


Colorado  Medicine  for  January,  1993 


Classified 


♦ PROPERTIES  FOR  SALE  OR  LEASE 

MAUI,  HAWAII.  Luxurious  2BR/2BA, 
2,100  sf  condominium  in  Kaanapali  Beach 
Resort,  1 00  yards  from  beach.  Everything's 
new!  Pool,  Jacuzzi,  Sauna,  Lighted  Tennis 
Courts,  Maids.  On  16th  fairway  Royal 
Kaanapali  Golf  Club.  Special  Fall/Winter 
Rates.  Call  985-9531 . 6/0892 

Professional  Office  Space 

Excellent  location  in  Wash  Park/DU  area. 
Share  common  pt.  waiting  room  w/  2 
internists  and  1 DDS.  Three  1 O'  X 1 O'  ops, 
reception  area.  Very  reasonable.  Call  Russ, 
688-8976.  12/0792 

YOU  OWE  ITTO  YOURSELF!  Winter  Park, 
very  plush  2 BR  Condo  with  all  amenities 
including  sauna,  athletic  club,  door  to  ski 
area  transportation.  For  sale  by  owner.  Call 
Werner  or  Ruth,  399-8919.12/0491 

EAGLE/VAIL  fully  equipped  luxury 
townhouse  on  golf  course,  4 bedrooms,  3 
baths,  reasonable  summer-winter  rates. 
Peter  Gehret,  MD  (303)  771-0456. 

1 2/0492 

EAST  VAIL  CONDO  2 BR  + loft.  Sleeps  6, 
3 full  baths,  fully  equipped  kitchen — TV 
VCR  fireplace-  excellent  condition  great 
view,  free  shuttle  to  slopes  weekly  winter 
rentals.  Arthur  Waldbaum  MD..  (303)  298- 
0222  4/0992 

VAIL  FOR  SALE-  50%  interest  in  3500 
sq.foot  vacation  home  above  the  Westin 
Hotel.  5 bedrooms,  3.5  baths,  4-cargarage, 
jacuzzi,  large  decks,  walk  to  Westin  lift. 
Call  Doug  Kirkpatrick.  Evenings  (303)  762- 
9050.  4/0193 

♦ EQUIPMENT  FOR  SALE  OR  LEASE 

X-RAY  MACHINE,  Three  years  old,  barely 
used,  excellent  condition.  Model:  Cont- 
inental 300  MA,  1 25  KVP,  elevating  table, 
wall  bucky;  Kodak  auto  processor  M35A. 
Contact  John  Lynn  MD.  at  80 1 N.  Cascade 
Ave.,  CS,  CO,  80903,  or  call  (719)  636- 
2388.  tfn/01 93 


♦ PRACTICES  FOR  SALE 

FAMILY  PRACTICE  FOR  SALE-  S.  Central 
Aurora,  CO-  30  patient  volume  per  day. 
Grossed  $ 230,000  last  year-Hospital 
assistance  with  setup.  Current  practitioner 
must  leave  July  1993.  Call  3-Minute 
Reader — 1-800-848-4912,  ext.  4410  or 
metro  Denver  (303)  756-6108.  2/1292 

Aurora,  Colorado.  Large  Family  Practice 
for  sale.  Could  be  excellent  opportunity  for 
internist  as  well.  Substantial  gross  income 
with  potential  for  much  more.  Doctor 
retiring.  Call  Marvin  N.  Cameron,  M.D.  1- 
303-364-4553  3/1192 

♦ SERVICES 

MEDICAL  LITERATURE  RESEARCH  - 
Want  to  review  literature  for  clinical  or 
legal  problem,  presentation  or  publication? 
Experienced  physician/author/educator  will 
do  customized  multiple  database  search  at 
reasonable  rates.  Call:  Bill  Milburn,  MD  at 
823-5083;  1-800-828-9259  (outside 
Boulder/Longmont).  12/0792 

HOME  MORTGAGE  LOANS 
LOW  DOC  PROGRAM  available  for 
physicians  and  other  health  professionals. 
Purchase  and  refinance.  Call  Milt,  a 
mortgage  bankerwith  1 8 years  experience. 
753-6262.  12/1292 

LOCUM  TENENS  SERVICE 
RADIOLOGISTS  AVAILABLE 
Since  1979,  Western  Physicians  Registry 
has  been  providing  radiologists  throughout 
the  Western  States.  For  locum  tenens  or 
permanent  positions,  please  call  Jim  Ellis, 
Director.  1-800-437-7676.  6/0992 

INOVATIONS  SHOULD  BE  PATENTED  if 

marketable.  For  more  information  call  Brian 
D Smith  of  Fields,  Lewis,  Pittenger  & Rost. 
Colo's  leading  patent  law  firm.  Mr.  Smith 
specializes  in  the  medical  arts.  (303)  758- 
8400.  12/1192 


Cash  Crunch? 

Overhead  Rising? 

Revenue  Dropping? 

Let  us  help  lower  your  costs.  YOU 
specialize  in  patient  care.  WE  specialize 
in  insurance  billing.  We  work  with 
Medicare,  Medicaid,  HMO's,  PPO's,  and 
other  third  party  carriers. 

We  don't  get  paid  until  you  get  paid. 

For  more  information  call  Advanced 
Professional  Services  (303)  341-1008. 

tfn/0492 

MEDICAL  TRANSCRIPTION  SERVICE- 
Guaranteed  quality  and  accuracy.  Cust- 
omized serviced  5 years  experience.  Free 
pickup  and  delivery  in  the  metro  area. 
Member  AAMT.  Call  Lesa  at  693-6652.2/ 
0193 

♦ MISCELLANEOUS 

EXPERIENCED  SECRETARIAL  SERVICESfor 
the  medical  professional.  Dictation, 
manuscripts,  insurance  reports,  large  or 
small  projects.  Computer  and  laser 
equipped.  Confidential  and  reliable.  SE 
Metro  area.  Call  Administrative  Support 
Personnel  (303)  770-4948.  2/1092 


STOP 


DOMESTIC 

VIOLENCE 


> 


J 


Check  The  Box 
On  Your  Colorado 
Tax  Return 

Domestic  Abuse  Assistance 
Programs  Help  Support 

■ Prevention  Programs 

■ Safe  Homes 

■ Counseling 

■ Intervention 


Colorado  Medicine  for  January,  1993 


Ruminations 


(def:  to  chew  again  what  has  been  chewed  slightly  and  swallowed;  to  REFLECT) 


by  Bill  Pierson , Managing  Editor 


The  Year  in  Medicine  - 1 982  (January,  1 983  AMA  summary  reprinted  from  Colorado  Medicine) 


• In  January,  1 983, 
we  looked  back  proudly 
on  a year  filled  with 
headline-making 
medical  achievements. 


• In  January,  1 993, 
historian  jurors  are 
still  out  on  the 
medical  notability 
of  1992. 


• It  may  be  best  remem- 
bered as  the  year  the  U.S 
population,  politician  and 
commoner  alike,  finally 
conceded  that  somehow 
all  Americans  must 
receive  health  care. 


AIDS:  That  is  the  acronym  for  acquired 
immune  deficiency  syndrome,  the 
official  name  for  a peculiar  mixture  of 
diseases  that  was  first  detected  in 
1981.  AIDS  has  reached  epidemic 
proportions  in  the  18  months  since  it 
was  recognized  as  a new  disease 
entity.  It  is  known  to  have  killed  more 
than  300  people,  making  it  more 
deadly  than  Legionnaires'  disease  or 
toxic  shock  syndrome  combined. 

Artificial  Heart:  The  surgery  to  implant 
the  polyurethane  plastic  and  alumi- 
num ]arvik-7  heart  into  Barney  Clark 
began  late  on  the  night  of  December 
1 , but  it  was  not  until  early  the  next 
day  that  the  mechanical  pump  was 
empowered  by  compressed  air  to 
support  a human  life.  The  historic 
event  came  one  day  short  of  the  1 5th 
anniversary  of  the  first  human  heart 
transplantation. Cyclosporin:  Much  of 
the  credit  for  the  improvement  in 
survival  after  organ  transplantation 
and  the  resurgence  of  transplantation 
surgery  is  due  to  this  drug,  which  was 
originally  isolated  from  fungi  in  soil 
samples  from  Wisconsin  and  Norway. 

Genetically  Engineered  Human 
Insulin:  Human  insulin  made  with 
recombinant  DNA  technology  by 
genetically  modified  bacteria  won  the 
Food  and  Drug  Administration's 
approval  for  marketing  this  year.  ...  the 
bioengineered  insulin  is  the  first  such 
product  made  by  gene  splicing  to  be 
marketed  for  use  in  humans. 

Hazards  of  Salt:  A coalition  of  health 
organizations,  federal  agencies  and 
food  processors  joined  forces  and 
found  a voluntary  way  in  which 
reliable  information  about  the  sodium 
content  of  packaged  foods  could  be 
made  available  to  physicians  and  to 
their  patients  whose  daily  sodium 
intake  must  be  limited  because  of  high 
blood  pressure. 

Lyme  Disease:  The  mystery  of  an  illness 
that  came  to  light  in  the  summer  of 
1 975  and  was  named  after  the 


Connecticut  town  where  the  first 
known  outbreak  occurred  has  been 
traced  to  a bacterium  transmitted  by 
the  bite  of  a tick. 

Medical  Lasers:  From  their  original  use 
by  ophthalmologists  to  weld  detached 
retinas  and  seal  leaking  blood  vessels 
in  the  eye,  lasers  continue  to  make 
inroads  to  areas  of  the  body  only  the 
scalpel  went  before.  A new  type  of 
laser,  pioneered  in  Europe  and  called 
the  YAG  laser  (for  neodymium  yttrium 
aluminum  garnet),  is  being  used  more 
and  more  for  sealing  bleeding  ulcers. 

Nuclear  Magnetic  Resonance:  Called 
NMR  for  short,  this  technology  and 
the  machinery  designed  to  apply  it 
have  the  potential  to  revolutionize  the 
way  physicians  look  inside  the  body 
and  the  view  they  get. 

Oncogenes:  A revival  of  a 10-year-old 
hypothesis  with  a startling  "cart  before 
the  horse"  twist  is  producing  some  of 
the  most  promising  research  ever  into 
the  mechanism  of  cancer.  The 
hypothesis  and  the  related  origin  of 
the  term  oncogene  (for  cancer-causing 
gene)  goes  back  to  work  done  in  the 
1960s  and  early  1970s  when  certain 
viruses  were  found  to  have  genes  that 
cause  cancer. 

Synthetic  Human  Interferon:  Gene- 
splicing techniques  have  led  to  the 
preparation  of  what  promises  to  be  an 
ample  supply  of  interferon.  In  early 
clinical  use,  the  synthetic  variety  has 
shown  anticancer  activity  in  patients 
with  non-Hodgkin's  lymphoma,  breast 
cancer,  chronic  lymphocytic  leukemia, 
Hodgkin's  disease  and  melanoma. 

Streptokinase:  This  clot-dissolving 
enzyme  was  approved  by  the  Food 
and  Drug  Administration  this  year  for 
use  in  treating  heart  attacks.  Given  to 
appropriate  patients  in  the  early  stages 
of  a heart  attack,  the  drug  holds  the 
potential  for  restoring  circulation  to  a 
choked-off  section  of  heart  muscle  and 
for  preserving  the  vitality  of  the  cells 
that  would  otherwise  die. 


38 


Colorado  Medicine  for  January,  1993 


WEALTH  SCIENCES  LIBRARY 


^Advocatingi^^jjj^^e  ®!PJhl44ffii®C#ssion  of  medicine" 


I'uary,  1993 


Volume  90,  Number  2 


Which  train  will  it  be?  stacks 

Health  Care  Reform;  Medicaid;  Workers  Comp 

Can  you  run  fast  enough,  doctor,  to  stay  out  of  its  way? 


Attend  the  CMS  Interim  Meeting  to  help  you  see  what  is  coming 
down  the  track  fSee  pg  53  and  following J. 


This  Issue: 

orporate  Practice  of  Medicine  . 

ealth  Care  Reform 

iterim  Meeting  Information 

MS  Targeted  by  Demonstrators 


Leigh  Truitt , MD,  President , CMS 

Page  49 

Page  53ff 

Page  66 


Can  you  imagine  a physician  who  would  run  a classified  advertisement  like  that? 

♦♦♦  Of  course  not  And  yet,  some  Colorado  physicians  choose  their  malpractice 
insurance  carrier  that  way.  Unfortunately,  when  they  sort  through  the  fine  print 
of  their  policy  they  often  discover  that  Brand  X wasn’t  even  the  low  bidder,  let 
alone  the  most  competent  to  avoid  or  defend  malpractice  suits,  or  to  provide 
vital  services  to  policyholders  and  the  Colorado  physician  community.  By 
all  means,  comparison  shop  if  you’re  in  the  market  for  malpractice  insurance. 
But  when  you  do,  be  certain  that  you  make  your  choice  based  on  all  the  facts 
and  figures.  ♦♦♦  We  are  confident  that  you  will  choose  Copic.  More  often  than 
not,  we  will  be  the  low  bidder,  once  you  reach  the  real  bottom  line. 

The  Copic  Bottom  Line. 

It’s  more  than  just  competitive  rates. 


Opic 


Copic  Insurance  Company 

RO.  Box  17540  • Denver,  CO  80217-0540  • (303)  779-0044  • 1-800-421-1834 


Colorado  Medicine 

February,  1993  Volume  90,  Number  2 


Cover  Story 


Health  Care  Reform,  Medic- 
aid, Worker's  Compensa- 
tion...They're  all  moving 
ahead.  But  can  we  get  them 
all  on  a track  that  won't  run 
over  physicians? 


n This  Issue... 


47  Corporate  Practice  of  Medicine — What  is  our  future? 

Leigh  Truitt ; MD,  President 
Colorado  Medical  Society 

48  Not  'Business  As  Usual'  at  CMS 

Sandra  L.  Maloney , Executive  Director,  CMS 

49  The  Future  of  Health  Care  in  Colorado 

Michael  P.  Thompson,  Ass't  Managing  Editor 

51  Governor  Romer  Addresses  Health  Care  Issues 

53  Special  Interim  Meeting  Section 

Who  serves  and  who  selects 


Departments 


Stuart  O.  Silverberg,  MD 

Schedule  of  Events 
Registration  Form 
List  of  Area  Restaurants 

60  Planning  for  Retirement 

Michael  P.  Thompson,  Ass't  Managing  Editor 

64  Book  Review  "AIDS  in  the  World" 

Thomas  H.  Coleman,  MD 


47  President's  Letter 

48  Executive  Director's  Update 
58  The  Lobby 

62  Committee  Update 

63  Letters 

69  Medical  News 
71  Classified  Advertising 
74  Ruminations 


66  Demonstrators  Come  to  CMS  Offices 

74  Corporate  Practice  of  Medicine — Not  a new  question 

Bill  Pierson,  Managing  Editor 


Colorado  Medical  Society 


COLORADO  MEDICAL  SOCIETY 
OFFICERS,  BOARD  MEMBERS  and  AMA  DELEGATES 


1992/1993  Officers 
Leigh  Truitt,  M.D. 

President 

Wm.  Carl  Bailey,  MD 

President-elect 

Terrance  J.  Sullivan,  M.D. 

Treasurer 

Stuart  O.  Silverberg,  M.D. 

Speaker  of  the  House 

David  C.  Martz,  M.D. 

Vice-speaker  of  the  House 

Sandra  L.  Maloney 

Secretary/Executive  Director 

Harrison  G.  Butler,  III,  M.D. 

(Immediate  Past  President) 


Board  of  Directors 

Board  of  Directors 

Thomas  J.  Allen,  MD 

Dieter  W.  Schneider,  MD 

Stephen  G.  Batuello,  MD 

David  Shander,  MD 

John  O.  Cletcher,  Jr.,  MD 

W.  George  Shanks,  MD 

Donald  G.  Eckhoff,  MD 

Susan  A.  Sherman,  MD 

John  E.  Ell  iff,  MD 

Gary  D.  VanderArk,  MD 

Jonathan  C.  Feeney,  MD 

Denis  J.  Winder,  MD 

David  C.  S.  Franklin,  MD 
Joel  M.  Karlin,  MD 

M.  Robert  Yakely,  MD 

George  M.  Kreye,  MD 
Muryl  L.  Laman,  MD 

AMA  Delegates 

Ted  T.  Lewis,  MD 

M.  Ray  Painter,  Jr.,  MD 

Maura  J.  Lofaro,  MS  IV 

Richert  E.  Quinn,  Jr.,  MD 

Louise  L.  McDonald,  MD 
Robert  R.  Montgomery, 

Mark  A.  Levine,  MD 

Legal  Counsel 
Robert  A.  Nathan,  MD 

Alternate  Delegates 

Kenneth  M.  Olds,  MD 

Robert  D.  McCartney,  MD 

Lothar  K.  Roller,  MD 

Robert  M.  Bogin,  MD 
Joel  M.  Karlin,  MD 

COLORADO  MEDICAL  SOCIETY  STAFF 


Executive  Office 

Sandra  L.  Maloney,  Executive  Director 
Mary  Lee  Johnston,  Executive  Admin.  Asst. 
Nancy  L.  Deter,  Manager,  Accounting 

Western  Slope  Office 

Dolores  M.  Bennett,  Executive  Secretary 

Division  of  Membership  Information  Services 

Timothy  H.  Roberts,  Director 
Diane  L.  LeHew,  Manager,  Support  Services 
Debra  M.  Jones,  Membership  Coordinator 
Beth  M.  Crusha,  Administrative  Assistant 

Division  of  Professional  Services 

Sandra  M.  Finney,  Director 
Lorraine  H.  Heth,  Program  Manager 
Kirsten  E.  Regalado,  Secretary 


Division  of  Health  Care  Policy 

Ellen  J.  Stein,  Director 

Marilyn  P.  Barton,  Program  Manager 

Lynn  R.  Livingston,  Administrative  Assistant 

Division  of  Health  Care  Financing 

Edie  K.  Register,  Director 
Marijo  M.  Parkin,  Program  Manager 

Division  of  Government  Relations 

Sue  Ellen  Quam,  Director 

Lorraine  L.  Koehn,  Program  Manager/Lobbyist 

K.  Suzanne  Hamilton,  Administrative  Assistant 

Division  of  Communications 

William  S.  Pierson,  Director 

Michael  P.  Thompson,  Communications  Spec. 

Gil  Maestas  II,  Communications  Staff 


COLORADO  MEDICINE  (ISSN-01 99-7343)  is  published  monthly  as  the  official  journal  of  the  Colorado  Medical  Society,  7800  E.  Dorado  PI.,  Englewood,  CO  801 1 1 . Telephone  (303)  779-5455.  Outside 
Denver  area,  call  1 -800-654-5653.  Second  Class  postage  paid  at  Englewood,  Colorado,  and  at  additional  mailing  offices.  POSTMASTER,  send  address  changes  to  COLORADO  MEDICINE,  P.  O.  BOX 
1 7550,  Denver,  CO  8021 7-0550.  Address  all  correspondence  relating  to  subscriptions,  advertising  or  address  changes,  manuscripts,  organizational  and  other  news  items  regarding  the  editorial  content 
to  the  editorial  and  business  office.  Subscriptions  are  available  for  $30  per  year,  paid  in  advance. 

COLORADO  MEDICINE  magazine  is  the  official  journal  of  the  Colorado  Medical  Society,  but  as  such  is  also  authorized  to  carry  general  advertising.  Publication  of  any  advertisement  in  COLORADO 
MEDICINE  does  not  imply  an  endorsement  or  sponsorship  by  the  Colorado  Medical  Society  of  the  product  or  service  advertised.  Published  articles  represent  opinions  of  the  authors  and  do  not  necessarily 
reflect  the  official  policy  of  the  Colorado  Medical  Society  unless  clearly  specified. 

Sandra  L.  Maloney,  Executive  Editor;  William  S.  Pierson,  Managing  Editor;  Michael  Thompson,  Asst.  Managing  Editor 


Member,  Colorado  Press  Association, 


Member,  Colorado  Broadcasters  Association 


44 


Colorado  Medicine  for  February,  1993 


Photo  by  Rocky  Mountain  News 


Leigh  Truitt,  MD 
President,  1992-1993 


President's 


A bill  will  be  proposed  this  year 
to  repeal  or  modify  Colorado 
Revised  Statutes  §12-36-11 7(1  )(m) 
of  the  Medical  Practice  Act  which 
prohibits  the  "corporate  practice  of 
medicine": 

Practicing  medicine  as  the  part- 
ner, agent,  or  employee  of,  or  in 
joint  adventure  with,  any  person 
who  does  not  hold  a license  to 
practice  medicine  within  this 
state,  or  practicing  medicine  as 
an  employee  of,  or  in  joint  ad- 
venture with,  any  partnership  or 
association  any  of  whose  part- 
ners or  associates  do  not  hold  a 
license  to  practice  medicine 
within  this  state,  or  practicing 
medicine  as  an  employee  of  or  in 
joint  adventure  with  any  corpo- 
ration other  than  a professional 
service  corporation  for  the  prac- 
tice of  medicine  as  defined  in 
§12-36-134. 

Colorado  Medical  Society  policy 
has  been  to  support  this  prohibition 
so  that  physicians  cannot  be  directly 
employed  by  hospitals,  insurers,  or 
similar  entities.  We  are  surveying  our 
membership  through  the  component 
and  specialty  societies  to  determine 
current  thinking  in  this  regard.  Many 
of  us  believe  that  overturning  this 
ban  will  lead  to  a loss  of  professional 
autonomy,  thereby  compromising 
patient  care. 

In  1 988  I first  became  aware  of 
the  term  "decapitalization,  which 
can  be  defined  as  reduction  in  the 
capital  of  a business  unit  relative  to 
the  unit's  capacity  to  generate 
value".1  Since  then,  we  have  seen 
the  trend  toward  less  vertical  integra- 


tion and  more  independence  of 
manufacturers  and  suppliers.  The 
least  successful  auto  and  computer 
makers  of  today  are  those  who 
produce  most  of  their  product 
components  in  house,  such  as 
General  Motors,  IBM  and  Digital.  On 
the  other  hand,  Toyota,  Dell  Com- 
puter, and  others,  who  coordinate 
many  different  suppliers,  deliver  high 
quality,  innovative,  low-cost  prod- 
ucts. 

First,  we  should  determine 
where  we  can  add  the  most  value  to 
the  system.  For  a hospital,  this  is 
certainly  capitalizing  and  managing 
inpatient  beds,  not  practicing 
medicine;  for  a specialist,  pursuing 
his/her  specialty  in  the  hospital, 
operating  room  or  office,  not  owning 
hospital  beds  or  other  capital 
equipment;  for  a primary  care 
physician,  managing  the  overall  care 
of  his/her  patients  in  many  different 
settings  with  the  aid  of  consultants, 
not  selling  pharmaceuticals  or 
medical  equipment. 

Next,  we  must  decide  if  the 
systems  and  assets  necessary  to 
provide  these  services  need  to  be 
fully  owned  to  be  controlled  ad- 
equately. 

• How  much  control  is  neces- 
sary or  desirable? 

• How  much  ownership  is 
essential  to  attain  or  retain  that 
much  control? 

For  example,  must  a radiologist 
own  an  MRI  scanner  in  order  to 
practice  radiology?  Is  the  maximum 
value  owning  the  machine  or 
reading  the  scans? 

Third,  "are  [there]  alternative 
owners  of  an  asset  [or  service]  to 
whom  the  asset  [or  service]  might  be 


worth  more[?]  This  could  be  a matter 
of  another  [entity's]  having  a tax 
position  that  it  can  exploit,  a greater 
debt  capacity,  a different  risk  profile 
or  a greater  ability  to  manage  risks 
because  of  a naturally  hedged 
position  or  special  skill". 

Finally,  how  do  we  achieve  an 
organization,  a commonality  of 
purpose,  that  permits  us  local 
ownership  and  autonomy  while  still 
providing  a high  degree  of  economic 
coordination?  This  is  the  challenge  of 
our  times. 

We  will  not  attain  it  by  insisting 
upon  control  through  ownership, 
confrontation,  or  demanding  profes- 
sional autonomy  without  financial 
responsibility.  Physicians,  hospitals 
and  insurers  must  look  to  new 
models  of  cooperation  so  that  all  can 
do  what  they  do  best  — thereby 
creating  maximum  value  in  the 
health  care  system. 

Please  let  us  know  your  thoughts 
on  the  corporate  practice  of  medi- 
cine issue.  At  a time  when  most 
other  industries  have  given  up  on 
total  vertical  integration,  there  are 
many  parts  of  the  health  care  system 
who  would  like  to  own  the  entirety. 


'This  discussion  is  based  on  Peter  Bisson, 
"Manager's  Journal:  Ownership  Isn't 
Always  the  Best  Strategy,"  The  Wall 
Street  Journal,  P.  A1 4,  December  5,  '88. 


Colorado  Medicine  for  February,  1993 


47 


XECUTI VE 


Director's  U pdate 


Sandra  L.  Maloney 
Executive  Director 
Colorado  Medical  Society 


It  is  not  'business  as 
usual'  at  CMS 

On  Friday,  January  15th,  my 
cellular  phone  rang.  Nothing  un- 
usual. It  was  one  of  our  CMS  staff 
members  on  the  line.  "You'd  better 
get  back  to  the  office,  we  have  an 
emergency.  There  are  people  in 
wheelchairs  protesting."  This  was 
stated  with  excitement  and  deep 
concern.  Well,  this  was  unusual. 

As  I made  the  short  drive  back  to 
CMS  headquarters,  my  head  was 
reeling.  I tried  to  figure  out  what 
policies  we  had  that  would  be 
upsetting  these  folks.  I arrived  at 
CMS  much  too  quickly  — I now  had 
to  face  the  protesters.  I knew  that  Dr. 
Bill  Bailey,  President-elect  lived 
close  by  so  I made  phone  contact 
with  him  and  asked  that  he,  too, 


return  to  CMS. 

I opened  the  back  door  to  our 
office  and  immediately  heard  the 
commotion.  There  were  strangers  up 
and  down  the  halls  of  CMS.  I 
recognized  one  of  the  individuals.  I 
remembered  that  this  person  and  I 
had  met  before  on  two  separate 
occasions.  Both  prior  instances  were 
while  I was  employed  at  BCBS  of 
Colorado.  At  that  point  in  time,  these 
folks  were  protesting  the  medical 
policies  on  reimbursement  for 
electric  wheelchairs.  I went  up  to  the 
fellow  and  re-introduced  myself  and 
told  him  that  this  was  the  third  time 
he  and  I had  been  involved  in  this 
type  of  situation.  FHe  just  grinned. 

I asked  them  to  all  gather  in  the 
lobby  so  that  we  could  talk  as  a 
group.  They  identified  themselves  as 
the  "American  Disabled  for  Atten- 
dant Programs  Today  (ADAPT)".  As  I 
stood  in  the  middle  of  this  large 
group,  I could  now  read  the  signs 
they  were  carrying.  Some  of  the 
signs  read,  "AMA  Kills",  "Abolish 
Apartheid,"  "Destroy  Nursing 
F-lomes",  etc.  I was  handed  a piece 
of  paper  that  outlined  their  "de- 
mands". (Actually,  their  demands  are 
of  the  AMA  more  so  than  CMS.)  The 
spokesperson  detailed  these  de- 
mands. In  short,  they  want  the  AMA 
to  1 ) direct  members  to  reduce 
nursing  home  referrals  by  50%  the 
first  year,  2)  require  all  member 
physicians  to  make  full  disclosure  of 
their  financial  interests  in  long  term 
care  facilities,  3)  mandate  that 
members  divest  themselves  of  all 
financial  interests  in  nursing  homes 
and  institutions,  and  4)  invite  ADAPT 
to  present  at  the  next  national  AMA 
conference.  They  also  reported  that 


ADAPT  had  scheduled  protests  at  14 
other  state  medical  societies  across 
the  nation.  I wondered  what  they 
would  ask  of  CMS. 

The  subject  they  became  most 
emotional  about  was  nursing  home 
placement.  They  want  alternatives. 
Their  cry  is  that  institutionalization 
will  limit  independence,  dignity,  self- 
determination,  community  participa- 
tion, productivity,  property  owner- 
ship, human  and  civil  rights.  As  this 
was  being  talked  about,  I vividly 
remembered  going  through  the 
agony  of  placing  my  mother  in  a 
nursing  home.  Probably  one  of  the 
most  difficult  decisions  I have  ever 
made.  My  mother  died  in  that 
nursing  home  two  years  later.  I have 
wondered  if  I could  have  extended 
her  life  by  providing  some  alternative 
living  arrangement.  This  I believe  is 
what  ADAPT  is  asking  for  - alterna- 
tives. 

It  did  not  appear  that  the  protest- 
ers were  going  to  leave  anytime 
soon.  Doctor  Bailey  and  1 offered  to 
provide  a representative  of  ADAPT 
the  opportunity  to  present  their 
concerns  and  ideas  to  a CMS 
committee.  They  seemed  openly 
surprised  by  our  offer.  They  de- 
manded that  I immediately  call  the 
AMA  and  tell  them  that  ADAPT  was 
at  CMS.  I did. 

Was  it  wrong  for  ADAPT  to 
invade  a private  office?  Yes.  Are 
they  wrong  to  identify  their  con- 
cerns? No. 

Using  a reasonable  approach, 
let's  hear  what  they  have  to  say. 
Perhaps  we  all  will  learn. 


48 


Colorado  Medicine  for  February,  1993 


of  Health  Care  in  Colorado 


Michael  P.  Thompson 
Assistant  Managing  Editor 


Universal  Health 
Care  Reform 

Colorado  Governor  Roy  Romer  and 
the  Department  of  Regulatory 
Agencies  (DORA),  unveiled  the 
preliminary  format  of  their  ideas  for 
health  care  reform  in  Colorado, 
called  CoioradoCare.  The  program  is 
intended  to  replace  all  existing 
health  care  insurance  coverage  for 
Colorado  citizens,  including  Medic- 
aid (but  not  Medicare)  with  a state 
funded,  managed  care  program. 

The  development  of  the  Coio- 
radoCare plan  was  mandated  by 
Colorado  Senate  Bill  92-4,  passed 
last  year.  The  bill  required  a prelimi- 
nary report  which  was  studied  by  a 
special  commission  at  their  meeting 
January  7.  Following  this  meeting, 
Governor  Romer  addressed  health 
care  reform  at  a meeting  of  the 
Denver  Forum  (see  Romer  Addresses 
Health  Care,  in  this  issue).  Coio- 
radoCare is  in  the  formative  stages  at 
this  time,  and  staff  have  recom- 
mended against  a previously  planned 
county  demonstration. 

A Three  Part  Plan 

According  to  documents  re- 
leased by  DORA,  CoioradoCare  has 
three  basic  parts.  "First,  the  state 
collects  through  a broad-based  tax, 
such  as  a payroll  tax,  a large  portion 
of  the  money  spent  on  health  care  in 
the  State  of  Colorado.  Second,  the 
state  contracts  with  a limited  number 
of  carriers,  such  as  FHMOs  and 
insurance  companies,  to  provide 
health  care  to  the  residents  of  the 
state.  These  carriers  must  offer  at 
least  a basic  package  of  health  care 
benefits,  but  they  may  supplement 


this  package  if  they  are 
able  to  deliver  health  care 
in  a more  cost-effective 
manner.  Third,  every 
resident  of  Colorado  selects 
one  of  the  carriers  as  their 
insurer.  Each  person  may 
select  any  carrier  without 
respect  to  family  income, 
health  status,  or  employ- 
ment. 

Where  Do  We 
Get  the 
Money? 

CoioradoCare  would  be  paid  for 
by  redirecting  funds  already  spent  for 
health  care  in  other  arenas.  Each 
employer  and  employee  would  be 
required  to  pay  a head  tax  to  the 
state,  in  place  of  current  health 
insurance  expenditures.  All  employ- 
ees previously  covered  under  plans 
at  work  would  receive  benefits 
through  CoioradoCare.  State  and 
Federal  Medicaid  funds  would  be 
diverted  into  CoioradoCare  and  all 
Medicaid  patients  would  be  covered 
under  the  program. 

Getting  employees  and  Medicaid 
recipients  into  the  program  covers 
the  majority  of  Colorado  citizens.  In 
order  to  cover  those  under  the 
federal  poverty  level,  but  not  eligible 
for  Medicaid,  a 25#  cigarette  tax 
would  be  imposed.  College  students 
would  pay  a head  tax  similar  to  that 
paid  by  employees.  Non-working 
non-poor  (such  as  retirees  living  on 
investment  income,  for  example) 
would  pay  a percentage  of  their 
income.  The  state  income  tax  would 
be  raised  from  5%  to  5.25%  to  cover 
additional  gaps  in  funding. 


Governor  Roy  Romer  has 
convened  people  from  all  walks 
of  life  and  all  parts  of  the  state  to 
help  finalize  "CoioradoCare",  the 
most  comprehensive  restructuring 
of  health  care  financing  and 
delivery  ever  attempted  in 
Colorado. 


continued  on  following  page... 


Colorado  Medicine  for  February,  1993 


49 


Photo  by  Gil  Maestas,  II 


"I  am  respectful  enough  of  the  difficulty  and  the  complexity  of  the  problem  that 
we  have  to  have  the  very  best  minds  of  Colorado  on  it,  and  we  must  include  all 
those  who  are  critical  to  its  execution:  those  of  you  who  are  providing  these 
services." 

Governor  Roy  Romer  to  the  CMS  House  of  Delegates 

September  13 , 1992 


Following  the  first  meeting  of  the 
commission  examining 
ColoradoCare,  the  Governor 
addressed  the  Denver  Forum  on 
the  rising  costs  of  Medicaid  and 
how  they  illustrate  the  need  for 
comprehensive  health  care 
reform.  (See  following  page.) 


Why 

ColoradoCare? 

Impetus  for  ColoradoCare  comes 
largely  from  growth  in  health  care 
expenditures  and  an  apparent  lack  of 
access  by  an  estimated  514,000 
Coloradans  without  health  insur- 
ance. Health  care  costs  are  estimated 
to  be  increasing  at  a rate  1 .5  times 
that  of  inflation.  The  aim  of  the 
program  will  be  to  bring  health  care 
expenditures  in  line  with  the  overall 
growth  of  the  economy,  provide 
universal  preventive  and  primary 
care  to  all  Coloradans  and  to  capi- 
tate the  amount  received  by  the 
insurers  administering  the  program. 

It  is  being  undertaken  at  this 
time,  despite  incoming  President 
Clinton's  promise  to  introduce  health 
care  reform  legislation  within  100 
days  of  taking  office.  Any  nation- 
wide plan  will  likely  be  administered 
by  states,  so  Colorado  would  have 
experience  already.  In  addition,  the 
enactment  of  Senate  Bill  92-4  brings 


Colorado  to  the  cutting  edge  of  the 
health  care  reform  movement 
nationwide.  Third,  Governor  Romer, 
as  head  of  the  National  Governor's 
Council,  will  have  significant  input 
to  the  process  of  formulating  a 
national  health  care  plan.  Besides, 
despite  the  best  intentions,  it  is 
possible  that  national  health  care 
reform  will  not  be  accomplished  this 
year. 

How  Does  It  Work? 

Under  the  original  concept  of 
ColoradoCare  (to  be  modified  by 
study  and  public  input),  a State 
Health  Authority  would  define  a 
basic  set  of  benefits  (yes,  that  is 
health  care  rationing)  for  which  all 
citizens  would  be  eligible.  The  state 
authority  would  gather  all  health 
care  money  into  a pool,  from  which 
a group  of  insurers  would  be  paid  a 
set  premium  to  provide  the  care. 

Coloradans  would  have  their 
choice  of  the  approved  plans.  Each 
insurer  could  compete  with  the 
others  by  offering  additional  benefits 
or  other  plan  enhancements  for  the 
same  money.  ("Managed  Competi- 
tion") The  advantage  would  go  to  the 
firm  which  can  provide  the  best 
package  for  the  premium  amount. 

No  resident  could  be  excluded 
because  of  age,  sex,  medical  or 
employment  status,  or  pre-existing 
conditions.  There  would  be  a 
uniform  billing  form,  and  all  pay- 
ments, utilization  review  and  cost 
reporting  would  be  standardized. 

In  order  to  have  input  to  the 
process,  write:  Health  Care  Reform 
Initiative,  Office  of  the  Governor, 

1 36  State  Capitol,  Denver  CO 
80203. 


50 


Colorado  Medicine  for  February,  1993 


Romer  Addresses  Health  Care 


"This  is  the  most  important 
policy  question  in  the  United  States, 
and  that  is,  'What  are  we  going  to  do 
about  health  care  costs?'"  That  was 
part  of  Colorado  Governor  Roy 
Romer's  remarks  to  the  Denver 
Forum  )anuary  6,  after  unveiling 
ColoradoCare,  his  vision  for  health 
care  reform  in  Colorado.  Governor 
Romer  told  the  group  about  Medic- 
aid, currently  the  biggest  health  care 
expenditure  in  Colorado  at  a billion 
dollars  per  year,  and  how  it  fits  into 
the  overall  picture  of  health  care 
financing  and  reform. 

"I'm  convinced  that,  next  to 
comprehensive  national  reform, 
turning  Medicaid  into  a managed 
care  system  holds  the  most  hope  for 
restraining  costs,"  the  governor  told 
the  group.  "Competitive  bidding, 
which  I propose  would  begin 
immediately,  is  a step  toward  the 
ultimate  goal  of  managed  care 
contracting  for  Medicaid." 

The  governor  called  upon  health 
care  providers  to  accept  assignment 
for  Medicaid  patients.  FHe  said  he 
sees  Medicaid  as  a part  of  a national 
managed  care  program  in  the  future 
and  that  expenditure  targets  are 
likely  to  be  used  by  the  Clinton 
administration,  in  connection  with 
health  care  rationing,  as  basic  tools 
for  constraining  health  care  costs. 

Governor  Romer  said  he  sees 
Medicaid  reform  as  only  a part  of  the 
larger  picture,  "The  solution  to  the 
Federal  Deficit  problem  hinges  upon 
controlling  health  care  costs,"  said 
the  Governor,  "I  tell  you,  there  is 
really  no  greater  threat  to  the  wealth 
of  the  nation,  the  competitiveness  of 
our  business  and  the  fiscal  stability  of 
our  families  and  our  governments 


than  the  current 
state  of  health 
care  in  America." 

"We're  kind 
of  at  a crossroads 
today  on  the  issue 
of  health  care," 
he  said,  "One 
road  is  the  one 
we're  on.  It  is  a 
road  of  steadily 
increasing  costs, 
and  steadily 
increasing 
burdens  on  families,  businesses  and 
governments.  It's  a road  where 
health  care  costs  rise  faster  than  the 
growth  of  our  economy,  and  as  a 
result,  the  health  care  benefits 
available  to  people  shrink  each  year. 
Government  shifts  costs  to  private 
businesses,  and  it  cuts  services  to  the 
poor.  And  the  businesses  shift  the 
costs  to  their  employees,  and 
individuals  pick  up  more  of  the 
health  care  tab,  or  go  without  care. 
That's  one  road. 

"The  other  road  requires  a sharp 
turn  in  our  thinking.  It's  the  road  of  a 
comprehensive  health  care  reform. 
It's  the  road  of  ColoradoCare,  which 
we  have  been  discussing  this  morn- 
ing. And  hopefully,  it's  the  road  of 
the  new  administration's  health  care 
plan. 

It's  on  this  road,  if  we  can 
change  the  structure  of  the  health 
care  system,  first,  we  can  constrain 
the  growth  in  health  care  costs,  so 
that  the  benefits  aren't  shrinking 
each  year,  and  second,  we  can  make 
sure  that  everyone  has  coverage  so 
the  system  gains  some  stability. 

Now  in  my  mind,  the  choice  of 
those  roads  is  clear.  The  tough 


Prominent  Denver  attorney 
Donald  Hoagland  and  CMS 
member  Fred  Abrams,  MD  are 
among  those  listening  as  the 
governor  describes  his  proposals. 


Colorado  Medicine  for  February,  1993 


51 


"What  we  have  here  is  universal  coverage,  absolute  portability, 
and  community  rated  programs." 


choices  we  face  today  in  Medicaid 
will  only  get  worse  unless  we  change 
the  road  we're  on." 

Governor  Romer  told  the  group 
that  Colorado  and  the  nation  face 
similar  problems  in  deciding  how  to 
pay  for  the  higher  costs  of  obtaining 
medical  care,  "Now  at  the  core  of 
both  the  President-elect's  proposal 
and  the  ColoradoCare  proposal  is  a 
central  idea.  It's  called  'managed 
competition'.  That  means  restructur- 
ing the  marketplace  to  encourage 
more  cost  conscious  decisions  by 
health  care  providers  and  purchas- 
ers. Now  for  Medicaid,  that  means 
we  need  to  move  more  toward 
managed  care." 

Under  ColoradoCare,  Medicaid 
would  be  only  one  part  of  a total 
state-administered  health  care 
program,  said  the  Governor,  "What 
we  have  here  is  universal  coverage, 
absolute  portability,  and  community 
rated  programs. ...Some  would  say 
there's  already  enough  cost  in  this 
system  to  cover  everybody,  you 
don't  need  to  add  any  more  dollars. 
My  own  view  is  that  if  that's  not  true, 
it's  close  to  being  true  and  with  a 
little  bit  more  we  could  make  it  true, 
because  we  are  now  shifting  so 
much  cost  to  others." 

During  the  meeting,  the  Gover- 
nor was  questioned  on  the  responsi- 
bility of  physicians  in  controlling 
health  care  costs,  "I  don't  think  we 
ought  to  single  out  doctors  as  over 
against  other  providers.  I think  we  all 
have  a responsibility  to  try  to  find  a 
system  that  does  the  job  at  less  cost." 

The  governor  said  that  physi- 
cians are  forced  to  practice  too  much 
defensive  medicine,  "We  have 
forced  doctors  to  use  many  more 


tests  than  you  really  need  to  practice 
good  medicine.  We  forced  that  by 
several  incentives  that  are  screwed 
up.  One  is  the  whole  litigation 
system  of  this  country.  ...Secondly 
there  are  some  doctors  who  may 
have  an  incentive  to  do  tests  because 
they  own  a piece  of  the  action.  I 
think  we've  got  to  get  rid  of  that." 

"Doctors  have  a responsibility  to 
be  a part  of  this  action,"  said  the 
Governor,  "but  also,  all  of  us  have 
got  to  be  a part  of  this."  He  put  some 
of  the  blame  for  high  health  care 
costs  on  unsophisticated  consumer- 
ism. As  an  example,  he  mentioned 
the  Denver  Public  Schools/Class- 
room Teachers  Union  feud  he 
mediated  a few  years  ago.  According 
to  Romer,  when  he  pointed  out  that 
there  were  several  options,  some 
more  expensive  than  others,  but  no 
incentive  to  choose  the  less  expen- 
sive option,  he  was  told  by  both 
sides  that  it  was  unimportant.  In 
other  words,  neither  side  considered 
prudent  use  of  health  care  dollars  as 
important  enough  to  discuss. 

The  governor  said  this  disparity 
also  happens  in  society  at  large, 
though  physicians  are  often  blamed 
for  high  costs,  "In  terms  of  just 
doctors,  I think  that  their  practices 
are  not  any  more  of  a problem 
sometimes  than  the  people  who  buy 
this  stuff.  I mean,  we  have  got  the 
wrong  incentives  working  here  to 
hold  the  price  down,  and  I think 
that's  the  bottom  line  of  this  whole 
change.  We've  got  to  get  the  right 
incentives  to  work  or  the  free  market 
isn't  going  to  work,  and  if  the  free 
market  doesn't  work,  folks,  you're 
going  to  have  a solution  that  you 
may  not  like." 


52 


Colorado  Medicine  for  February,  1993 


Who  serves  and 
who  selects 


by  Stuart  O.  Silverberg,  M.D. 

Speaker  of  the  House  of  Delegates 
Colorado  Medical  Society 


The  direction,  role  and  legislative 
policies  of  the  Colorado  Medical 
Society,  its  Board  of  Directors  and 
Executive  Committee  is  established 
every  six  months  by  the  House  of 
Delegates. 

Any  organization  of  decisive, 
independent  minded,  and  strong- 
willed  physicians  must  have  referees 
to  keep  the  process  on  course. 

Reference  Committees  provide 
this  role.  They  hear  testimony  - some 
articulate,  some  passionate,  some 
emotional  - but  all  committed  and 
significant.  Once  testimony  is 
complete,  the  committee  has  the 
thankless  task  of  consolidating  this 
wide  diversity  of  thought  and 
opinion  into  a single  position  on 
which  the  House  of  Delegates  can 
vote...  Referees  are  never  beloved  - 
but  they  are  important! 

To  insure  that  every  delegate  has 
an  equal  chance  to  serve  on  a 
Reference  Committee,  the  Speaker  of 
the  House  is  requesting  that  each 
Component  Society  poll  their 
Delegates  for  those  members  inter- 
ested in  serving  on  a specific  Refer- 
ence Committee  and  submit  their 


"Referees  are  never 
beloved  - but  they  are 
important !" 


nominees  in  order  of  preference  to 
the  Speaker  by  February,  1993. 

The  Speaker  intends  to  appoint 
all  nominees  by  order  of  preference 
to  the  Reference  Committees  - one 
delegate  from  each  Component 
Society.  In  the  event  of  the  primary 
Delegate's  absence,  the  Component 
Society's  second  preference  will  be 
appointed. 

Any  CMS  member  interested  in 
serving  on  a Reference  Committee  is 
urged  to  contact  his/her  Component 
Society's  leadership. 


CompHealth,  the  nation  s premier  locum  tenens  organization,  now  provides  local 
primary  care  coverage  and  flexible,  part-time  opportunities  for  physicians  in  the 
greater  Denver  area.  Call  today  to  discuss  daily,  weekly,  weekend,  evening,  or 
monthly  coverage  for  your  practice,  or  to  find  out  more  about  building  a flexible 
locum  tenens  practice  right  here  in  the  greater  Denver  area. 


303-777-8002 

P.O.  Box  100218,  Denver,  CO  80250 


CompHealth/Denver 

Local  Staffing  Network 


\ou  didn’t 
spend 
umpteen 
years  in 
school  in 
order  to 
become  a 

bill 

collector. 


Collecting  money  from 
slow  paying  patients  is  critical 
to  your  practice.  But  you  didn’t 
spend  all  those  years  in  school 
to  become  a bill  collector. 

And  that’s  where  I.C. 
System  can  help. 

First  of  all,  we  have  the 
resources  and  expertise  to  do 
the  job.  And  while  we’re 
tenacious,  we  treat  your 
delinquent  patients  with 
courtesy  and  respect. 

In  fact,  our  work  is  en- 
dorsed by  over  1,200  profes- 
sional associations  and  societ- 
ies, including  the  Colorado 
Medical  Society.  And  no 
matter  where  you’re  located  or 
where  your  debtors  live,  we 
have  local  representatives  to 
service  your  account. 

But  most  important,  we 
guarantee  results,  by  collect- 
ing at  least  ten  times  the 
amount  of  our  retainer. 

To  find  how  the  I.C. 

System  approach  can  work  for 
you,  call  toll  free  (800)  824- 
9469,  ext.  330. 


fftl.C.  System 

The  SvMcni  J W<irk^ 


Colorado  Medicine  for  February,  1993 


53 


Colorado  Medical  Society 
Interim  Meeting— April  3-4,  1993 


Friday,  April  2,  1 993 


1 1 :30  am  - 1 :00  pm 

Finance  Committee 

12:00  N 

— 1 :30  pm 

Lunchieon 

1 :00  pm  — 4:00  pm 

Board  of  Directors 

1 :30  pm 

— 4:00  pm 

Reference  Committee 

3:00  pm  — 5:00  pm 

FHealthi  Care  Reform — 

1 :30  pm 

— 4:00  pm 

Reference  Committee 

Medicaid 

3:30  pm 

— 6:00  pm 

Reference  Committee 

3:00  pm  — 5:00  pm 

FHealthi  Care  Reform  — 
Worker's  Compensation 

3:30  pm 

— 6:00  pm 

Reference  Committee 

5:00  pm  — 7:00  pm 

Registration 

Sunday,  April  4,  1993 

5:30  pm  — 7:00  pm 

Welcome  reception 

7:00  am 

-- 1 1 :00  am 

Registration 

sponsored  by  El  Paso  County 
Medical  Society 

7:00  am 

— 8:30  am 

Arapahoe  Medical  Society 
caucus 

6:30  pm  — 9:30  pm 

Women  in  Medicine  Section 
Dinner  and  Business  Meeting 

7:00  am 
7 :00  am 

— 8:30  am 

— 8:30  am 

AuroraAdams  County 
Medical  Society  caucus 
Boulder  County  Medical 
Society  caucus 

Saturday,  April  3,  1993 

7:00  am  — 5:00  pm 

Registration 

7 :00  am 

— 8:30  am 

Denver  Medical  Society 
caucus 

7:00  am  — 9:00  am 

Reference  Committee 
Breakfast 

7 :00  am 

— 8:30  am 

El  Paso  County  Medical 
Society  caucus 

7:00  am  — 8:30  am 

Nominating  Committee  Open 
Forum 

7:00  am 

— 8:30  am 

Larimer  /Weld  County 
Medical  Societies  caucus 

7:00  am  —8:45  am 

Congress  of  Medical 
Specialties 

7:00  am 

— 8:30  am 

Pueblo/Western  Slope 
Medical  Societies  caucus 

8:30  am  — 9:00  am 

Credentials  Committee 

8:00  am 

— 8:30  am 

Credentials  Committee 

9:00  am  — 9:30  am 
9:30  am  — 1 1 :45  am 

FHouse  of  Delegates  Opening 
Session 

General  Membershiip  Meeting 

8:30  am 

— 12:00  N 

FHouse  of  Delegates 
Concluding  Session 

54 


Colorado  Medicine  for  February,  1993 


INTERIM  MEETING  REGISTRATION 

1993  Interim  Meeting  of  the  Colorado  Medical  Society,  April  3-4,  1993,  Sheraton  Colorado  Springs  Hotel 

Name  (please  type  or  print) 

Name  of  Spouse/Guest  (if  attending)  

Component  Society Office  Phone  


Please  check  all  that  apply 


□ Women  in  Medicine 
Section 

□ Young  Physicians 
Section 

□ Resident  Physicians 
Section 

□ Hospital  Medical  Staff 
Section 

■ □ Component  Society 
Executive 

□ Program  Speaker 

□ Press 

□ Other 

If  you  are  not  a member  of  CMS,  please  provide  the  following: 
Company/Organization  


Title 

Be  sure  to  complete  both  sides  of  the  form. 


Hotel  Reservation  form  below 
Send  directly  to  hotel,  not  to  CMS 

Sheraton  Colorado  Springs  Hotel 
2886  South  Circle  Drive 
Colorado  Springs,  CO  80906-4199 
(7 19)576-5900  FAX  (71 9)  576-7695 


Advance  Reservation  Request 

Reservations  are  accepted  on  a guaranteed  basis  only 
(Please  complete  and  remit  early.) 


Guaranteed  Reservations 

• Send  a deposit  of  one  night's  room  charge  plus  tax  (8.6%) 

• Include  your  credit  card  number  (AMEX/DC/MCAdsa/CB) 

If  you  do  not  cancel  with  hotel  48  hours  prior  to  arrival, 
you  will  be  billed  by  the  credit  card  company  for  one 
night's  lodging,  plus  tax. 

Cancellations 

Please  don't  be  a "NO  SHOW."  If  you  cannot  stay  with  us, 
cancel  your  reservation  by  calling  the  hotel  directly  at  least  48 
hours  prior  to  arrival  and  obtain  a Cancellation  Number. 


Check-Out 

Check-out  time  is  1 1 :00  a.m. 

Check-In 

Check-in  is  not  guaranteed  prior  to  3:00  p.m. 

Special  Note 

Reservation  deadline  is  March  1,  1993.  The  preferred  rate  will  be 
extended  to  CMS  members  on  a space  available  basis  after  March  1 . 

For  additional  information  or 

group  reservations  - call  719-576-5900. 


Colorado  Medicine  for  February,  1993 


55 


Reservations  for  Events  and  Meetings 

(Reservation  deadline  is  March  19,  1993.  Reservations  accepted  on  a first-come,  first-served  basis.) 


Number  of 
Reservations 

Friday,  April  2,  1993 

3:00-5:00  pm  Health  Care  Reform — Medicaid  

3:00-5:00  pm  Health  Care  Reform — Worker's 

Compensation  

5:30-7:00  pm  Welcome  Reception  sponsored  by 

El  Paso  County  Medical  Society  


Amount 

Enclosed 

Complimentary 

Complimentary 

Complimentary 


Saturday,  April  3,  1993 

1 2 Noon-1 :30  pm  Luncheon  Complimentary 


Hotel  Reservations 

Please  use  the  hotel  reservation  form  in  this  issue  of  Colorado  Medicine  to  make  your  reservations  directly  with  the 
Sheraton  Colorado  Springs  Hotel.  The  deadline  for  room  reservations  is  March  1,  1993.  The  preferred  rate  will  be 
extended  to  CMS  members  on  a space  available  basis  after  March  1 . 

Meeting  Registration 

Please  submit  a registration  form  by  March  19,  1993,  if  you  plan  to  attend  this  Interim  Meeting.  We're  delighted  to 
receive  it  by  mail,  fax,  or  phone.  We  can  check  you  in  more  quickly  and  efficiently  if  you've  pre-registered,  in 
addition  to  providing  more  accurate  and  therefore  cost-saving  guarantees  for  our  food  functions.  Thanks! 


Messages 

For  your  convenience,  a message  board  will  be  provided  at  the  CMS  registration  desk.  The  hotel's  phone  number  is 
719-576-5900.  (You  may  want  to  leave  this  number  with  someone).  If  you  need  to  be  contacted,  ask  the  hotel 
operator  to  transfer  the  call  to  the  CMS  registration  desk  or  CMS  office. 


What  To  Do 

Complete  and  return  to  Colorado  Medical  Society,  PO  Box  1 7550,  Denver,  CO  8021  7 (303-779-5455  or 

1-800-654-5653),  or  FAX  to  303-771-8657. 



Hotel  Reservation  Information 


Name  of  Group:  Colorado  Medical  Society 

Last  Name First Middle 

Company  Name Co.  Phone 

Address 

City State Zip 

Home  Address _ _ Phone 


City 


State 


Zip. 


Share  with:  Last  Name. 


First 


Last  Name 


First 


Group  Code 


□ No  Smoking 
Room 


Rate  Check  Type 

_ _ _ Requested 


Single 

$58.00 

Double 

$68.00 

Triple 

$78.00 

Quad 

$88.00 

Guest  rooms  are  held  by  the  hotel  for  your  group 
as  listed  below.  Any  variation  is  subiect 
to  availability. 

Meeting  Dates  April  2-4,  1993 

Please  make  my  reservation  for  the  following  dates: 

ARRIVAL  

DEPARTURE  

(We  must  have  this  information  in  order  to  make  your  reservation.) 

Guaranteed  Reservation 

□ Deposit  included 

□ AM/Ex  □ DC  □ MC  □ VISA  QCB 

Credit  card  No.  

Expiration  date  

Signature 


56 


Colorado  Medicine  for  February,  1993 


Dear  CMS  member, 

The  1 993  interim  meeting  will  be  taking  place  in  Colorado  Springs  on  April  2-4.  If  you  are  not 
familiar  with  Colorado  Springs  area  and  would  like  to  dine  out  while  in  town,  the  following  list 
may  be  useful. 


Hatch  Cover 

576-5223 
Steak  & Seafood 
Moderate  to  Expensive 

Bell's  Deli 

154  Cheyenne  Mountain  Blvd. 
576-8633 

Casual  Neighborhood  Dining 
Inexpensive  to  Moderate 

Luigi's 

947  S.  Tejon  Street 

632- 0700 
Italian 
Moderate 

Izzi's 

1731  Mount  Washington  Ave. 
473-5308 

Italian  & Continental 
Moderate 

Peppino's 

919  Arcturus  Drive 
475-1077 

New  Orleans  Cuisine 
Moderate 

Ritz  Grill 

1 5 S.  Tejon 
635-8484 
Nouvelle  Cuisine 
Moderate 

Edelweiss 

34  E.  Ramona  Ave. 

633- 2220 
German 
Moderate 

Mekong 

3219  S.  Academy  Blvd. 

390-4223 

Vietnamese 

Inexpensive  to  Moderate 


Howard's  Pit  Barbecue 

2814  E.  Fountain  Blvd.-  473-1  390 
301  9 W.  Colorado  Ave.-  473-7427 
Colorado  & Fountain — 
Inexpensive 

Estela's 

925  S.  8th  Street 

575-0244 

Mexican 

Inexpensive  to  Moderate 

Papagyos 

301  Manitou  Ave. 

685-9458 

Mexican 

Moderate 

Zeb's 

945  S.  8th  Street 
473-9999 

Fish  & the  best  ribs  anywhere 
Moderate 

Imperial  Wok 

5674  N.  Academy  Blvd. 

548-0300 

Chinese 

Moderate 

Craftwood  Inn 

404  El  Paso  Blvd. 

685-9000 
Colorado  Game 
Moderate  to  Expensive 

La  Petite  Maison 

1015  W.  Colorado  Ave. 

632-4887 
Country  French 
Expensive 

The  Peppertree 

888  W.  Moreno  Ave. 

471-4888 

Continental  with  the  best  pepper 

steak  around 

Expensive 


Charles  Court 

Broadmoor  Hotel 
1 Lake  Circle 
577-5733 
American 

Very  Expensive 

Penrose  Room 

Broadmoor  Hotel 
1 Lake  Circle 
577-5733 

Continental  & Nouvelle 
Very  Expensive 

The  Tavern 

Broadmoor  Hotel 
1 Lake  Circle 
577-5733 

Steak/Prime  Rib/Seafood 
Moderate 

Remington's 

3225  Broadmoor  Valley  Road 

576-4600 

Continental 

Expensive 

Maxi's 

Red  Lion  Hotel 
1 775  Cheyenne  Mtn.  Blvd. 

576- 8900 
American 
Moderate 

Golden  Bee 

I Lake  Circle 

577- 5776 

for  Drinks  and  Fun 


Colorado  Medicine  for  February,  1993 


57 


■ 


Lobby 


Alan  Rapp,  MD  Chairman 
Council  on  Legislation 


" ...  act  more  like  an 
HMO  — pay  our  provid- 
ers a flat  amount  and  give 
them  responsibility 

Roy  Romer,  Governor 
State  of  Colorado 


Our  state  leaders  will  be  working 
during  this  legislative  session  to 
promote  their  vision  of  how  health 
care  services  should  be  delivered  in 
Colorado.  Finding  adequate  funding 
for  the  state's  public  health  care 
programs  has  always  been  a chal- 
lenge for  the  Governor  and  legisla- 
tors. Under  the  Amendment  1 
provisions,  enacted  by  Coioradans  in 
November's  election,  this  challenge 
has  grown  even  harder  to  meet. 

We  believe  you  should  know, 
first  hand,  what  solutions  leadership 
is  offering  . We  quote  directly  from 
Governor  Romer's  "State  of  the 
State,"  Senator  Norton's  "State  of  the 
Senate"  and  Representative  Berry's 
"State  of  the  House"  messages. 

CMS  must  be  involved  in  these 
discussions.  Our  leadership  will  be 
charged  with  setting  and  critiquing 
the  goals  of  the  Medicaid  program, 
and  how  best  we  can  achieve  them, 
while  still  providing  quality  care  to 
the  Medicaid  patients.  We  will  need 
your  advice  and  assistance  in  this 
effort. 

On  Medicaid  Reform  - 
Colorado  Governor  Romer 

"To  be  bold,  we  must  overhaul 
the  structure  of  Medicaid  by:  1 ) 
immediately  beginning  competitive 
bidding  for  services,  and  2)  moving 
from  the  current  system  to  a system 
that  takes  advantage  of  the  benefits 
of  managed  care,  like  and  FHMO. 

This  year,  we  will  spend  $1 
billion  in  state  and  federal  Medicaid 
funds  to  provide  medical  care  for 
Colorado's  poor,  nursing  home  care 
for  the  elderly,  and  long-term  care 
for  the  disabled.  These  Medicaid 


costs  are  growing  at  20%  per  year. 

If  we're  going  to  be  bold  in 
redefining  government,  we  must 
fundamentally  change  Colorado's 
Medicaid  program.  We  have  to  stop 
paying  providers  for  each  individual 
service  to  a Medicaid  enrollee. 
Instead,  we  must  act  more  like  an 
HMO  — pay  our  providers  a flat 
amount  and  give  them  responsibility 
for  delivering  all  necessary  health 
care  within  their  own  budget. 

It's  the  best  way  to  hold  down 
costs  throughout  the  system. 

At  the  current  rate  of  growth, 
Medicaid  is  the  single  greatest  threat 
to  the  stability  of  our  state  budget. 

The  problem  we  face  with 
Medicaid  is  closely  tied  to  the 
problems  of  our  nation's  health  care 
system. 

In  Washington,  the  incoming 
administration  has  made  health  care 
a top  priority.  As  chairman  of  the  50 
governors  (National  Governor's 
Conference),  I and  others  are  work- 
ing with  the  transition  team  to  craft 
that  reform  proposal.  In  Colorado, 
we're  moving  ahead  with  our  own 
statewide  reform  proposal  called 
ColoradoCare.  If  there  is  no  national 
solution,  we  will  submit  legislation 
for  ColoradoCare  as  early  as  1 994. 

But  we  must  start  right  now  by 
authorizing  the  Medicaid  program  to 
begin  competitive  bidding  for 
services.  It's  the  first  step  in  our 
reform.  With  competitive  bidding, 
we  will  be  able  to  seek  our  low  cost, 
high  quality  providers  of  health  care 
and  give  them  contracts  to  provide 
services  to  people  on  Medicaid. 

Now,  I know  some  providers 
rely  upon  Medicaid  for  much  of  their 
income.  They  will  need  to  demon- 


58 


Colorado  Medicine  for  February,  1993 


"At  the  current  rate  of  growth,  Medicaid  is  the  single  greatest 
threat  to  the  stability  of  our  state  budget." 

Roy  Romer,  Governor 
State  of  Colorado 


strate  that  they  are  cost-efficient  if 
they  want  to  keep  doing  business 
with  us.  And  Medicaid  enrollees  will 
lose  some  of  the  choice  they  cur- 
rently have. 

We  need  to  be  sensitive,  but  fair 
and  firm,  in  making  these  changes. 
We  also  need  to  be  sensitive  to  the 
availability  of  services  in  different 
geographic  regions  within  the  state 
when  begin  competitive  bidding. 
Medicaid  competitive  bidding  is  the 
right  thing  to  do,  and  we  must  begin 
it  immediately." 

President  of  the  Senate  - 
Senator  Tom  Norton: 

Another  topic  of  major  concern 
this  session  is  health  care  — specifi- 
cally Medicaid.  As  you'll  recall,  we 
passed  a bill  last  year  that  would 
have  allowed  us  to  work  toward  the 
replacement  of  Medicaid  with  an 
innovative,  cost  effective  approach 
to  providing  medical  assistance  to 
low  income  people. 

The  governor  disagreed  and 
vetoed  the  bill  voicing  what  was 
termed  a "grave  concern"  over  the 
possibility  of  Colorado  losing 
funding  for  the  medically  indigent. 
Now,  we  are  in  a position  of  not 
only  dealing  with  runaway  Medicaid 
costs,  but  pressure  for  a national 
health  care  system  which  will  create 
similar  problems.  Therefore,  we  must 
find  a state  solution  which  eliminates 
the  need  for  further  intervention. 


Speaker  of  the  House  - 
Representative  Chuck  Berry: 

No  challenge  Colorado  faces  is 
more  important  than  health  care  for 
our  citizens  Yet  the  future  of  this 
issue  may  be  less  in  our  hands  than 
in  those  of  decision-makers  in 
Washington.  Federal  mandates  cause 
spiraling  increases  in  Medicaid  and 
deny  us  the  discretion  we  should 
have  in  state  budgeting.  We  must 
work  with  the  Governor  to  seek 
more  flexibility  from  the  federal 
government  in  the  operation  of  our 
Medicaid  system.  In  addition,  the 
new  President  has  promised  America 
a program  of  national  health  insur- 
ance, and  we  must  recognize  that 
congressional  action  on  this  initiative 
could  pre-empt  anything  we  do  here 
at  the  state  level. 


//. . . pressure  for  a national 
health  care  system  which  will 
create  similar  problems. " 

Senator  Tom  Norton 
President  of  the  Senate 

"...  congressional  action 
...  could  pre-empt  any- 
thing we  do  here  at  the 
state  level." 

Representative  Chuck  Berry 
Speaker  of  the  House 


Colorado  Medicine  for  February,  1993 


59 


lanning  for  Retirement 


by  Michael  P.  Thompson 
Assistant  Managing  Editor 


" The  Real  Mid-Life  Crisis " 


As  you  drift  into  your  middle  years, 
you  begin  to  have  those  feelings  of 
doubt.  Oh,  I'm  not  talking  about  the 
question  of  whether  you've  still  "got 
it."  No,  this  is  the  question  Duane  D. 
Freese  calls  "The  Real  Mid-Life 
Crisis."  That's  the  question,  "Am  I 
really  prepared  for  retirement?" 

Unlike  an  employee  of  a corpo- 
ration, the  physician  often  has  to 
plan  and  work  for  his  or  her  own 
retirement  benefits.  How  would  you 
like  a knowledgeable  friend  to  step 
you  through  your  retirement  plan- 
ning? The  next  best  thing  may  be 
Retirement  Planning:  The  Real  Mid- 
Life  Crisis  by  Duane  D.  Freese. 

Now  before  you  begin  com- 
plaining that  you  haven't  got  the 
time  to  plan  for  retirement,  consider 
the  alternative.  Oh,  right.  That's  not 
the  brightest  version  of  your  golden 
years,  is  it?  Just  because  you've  made 
a few  smart  investments  doesn't 
necessarily  mean  you'll  have  enough 
to  sustain  your  desired  lifestyle 
without  working. 

Ftow  do  you  know  you're  really 
ready?  Well,  the  answer  is  not  that 
simple  or  that  easy.  Mr.  Freese  says, 
"If  it  was  so  simple,  you  wouldn't 
need  a book.  If  it  was  so  simple,  all 
the  advice  you  would  need  would  be 
available  on  a three-by-five  index 
card."  But  that  is  not  the  case.  "You 
want  me  to  tell  you  not  to  worry 
about  it,"  says  Mr.  Freese,  "That 
there's  some  simple  way  to  handle 
your  retirement.  Tough." 

Those  comments  tell  you 
something  about  his  writing  style, 
don't  they?  He's  not  going  to  give 
you  some  get  rich  quick  and  easy 
scheme.  That's  not  to  say  it's  too 
difficult  for  a competent  professional 


such  as  you,  but  you  do  need  to  put 
in  the  effort.  He  also  isn't  going  to 
give  you  a bunch  of  professional 
gobbledygook  or  some  scary  stories. 
You  can  do  it  if  you  want. 

This  book  is  very  practical. 
Chapter  One  advises  you  to  figure 
out  where  you  are.  "Budgeting  is 
boring,"  he  says,  "but  it  is  also  basic. 
It  makes  everything  else  easier." 

From  the  worksheet  that  shows  you 
your  present  financial  status,  he  takes 
you  through  the  ever  more  pleasant 
countryside  of  figuring  your  net 
worth  and  what  kind  of  income  you 
want  when  you  retire. 

Now,  how  are  you  going  to  pay 
for  it?  Many  people  are  drastically 
overinsured.  Others  have  bought  the 
myth  that  term  insurance  is  "one  size 
fits  all."  How  can  you  improve  your 
present  income  status?  One  way  is  a 
weekly  food  menu.  You'll  have  to 
read  the  book  to  find  out  how. 

Basic  investment  strategies  are 
covered  next,  such  as,  saving  the 
cash  to  start  the  process.  Then  you 
have  to  keep  track  of  it.  (You  always 
loved  to  count  your  money  anyway, 
didn't  you?)  You  even  have  to  face 
the  final  curtain,  deciding  who  will 
get  what  and  how  to  provide  for  your 
loved  ones  after  you're  gone.  (You 
were  planning  on  leaving,  weren't 
you?) 

If  you  want  a book  of  magic 
answers  and  pots  of  gold,  you 
haven't  found  it  here.  If  you  want  a 
good,  practical  guide  to  getting  ready 
for  retirement,  pick  up  a copy  of 
Retirement  Planning:  The  Real  Mid- 
Life  Crisis  by  Duane  D.  Freese, 
©1990,  International  Publishing 
Corporation,  625  N.  Michigan  Ave, 
Chicago,  IL  60611. 


60 


Colorado  Medicine  for  February,  1993 


Defined  Benefit  Plans 

Time  for  a closer  look 


A recent  change  in  the  position  of 
the  IRS  on  early  retirement  ages  has 
brought  renewed  life  to  Defined 
Benefit  Plans.  As  a result  of  Tax 
Court  developments,  Congressional 
input,  and  testimony  from  retirement 
professionals,  it  appears  the  use  of 


early  retirement  ages  between  60-65 
will  no  longer  be  challenged  by  the 
IRS,  provided  proper  plan  design. 

This  change  in  the  position  of 
the  IRS  together  with  current  Cost  of 
Living  Adjustments  (COLA)  for 
retirement  benefits  opens  the  door 


for  younger  physician  owners  who 
wish  to  accumulate  assets  quickly 
and  retire  earlier.  As  you  can  see 
from  the  numbers  below,  the  De- 
fined Benefit  Plan  can  once  again  be 
an  important  retirement  and  tax 
planning  alternative. 


Defined  Benefit  Plan  Contributions  at  Selected  Ages 


43 

44 

45 

46 

47 

48 

49 

50 

51 

52 

53 

$30,000 

27,500 

29,135 

30,990 

33,094 

35,506 

38,302 

41,588 

45,510 

50,281 

56,220 

63,827 

$40,000 

30,800 

34,330 

38,341 

42,992 

47,341 

51,069 

55,451 

60,680 

67,042 

74,960 

81,670 

$50,000 

30,800 

34,330 

38,341 

42,992 

48,431 

54,858 

62,542 

71,863 

75,030 

78,299 

81,670 

$60,000 

30,800 

34,330 

38,341 

42,992 

48,431 

54,858 

62,542 

71,863 

75,030 

78,299 

81,670 

$70,000 

30,800 

34,330 

38,341 

42,992 

48,431 

54,858 

62,542 

71,863 

75,030 

78,299 

81,670 

$80,000 

30,800 

34,330 

38,341 

42,992 

48,431 

54,858 

62,542 

71,863 

75,030 

78,299 

81,670 

$90,000 

30,800 

34,330 

38,341 

42,992 

48,431 

54,858 

62,542 

71,863 

75,030 

78,299 

81,670 

$100,000 

30,800 

34,330 

38,341 

42,992 

48,431 

54,858 

62,542 

71,863 

75,030 

78,299 

81,670 

$1 10,000 

30,800 

34,330 

38,341 

42,992 

48,431 

54,858 

62,542 

71,863 

75,030 

78,299 

81,670 

The  chart  assumes  no  other  prior  plans  or  contributions.  Actuarial  Assumptions:  Normal  Retirement  Age  = 60;  Pre-Retirement 
Interest  = 8%;  Post  Retirement  Interest  = 5%;  Mortality  Table  = Fern  83A;  Salary  Scale  = 5%;  COLA  = 4%. 


For  many  years  the  Defined 
Benefit  Plan  had  been  one  of  the 
most  attractive  tax  shelters  for 
physician  business  owners.  The 
Defined  Benefit  Plan  can  provide 
high  levels  of  deductible  contribu- 
tions and  primarily  benefits  older 
employees.  However,  changes  in  the 
tax  law  limited  the  level  of  benefits 
from  these  plans  which  lowered  the 
level  of  contributions  permitted  and 
in  turn  diminished  the  appeal  of 
these  plans. 

Now  that  the  use  of  earlier 
retirement  ages  appears  to  have 
successfully  passed  IRS  scrutiny,  the 
Defined  Benefit  plan  will  once  again 
make  sense  for  the  younger  Physi- 
cian owner.  For  example,  for  a 45 
year  old  physician  owner  who  has 
never  had  a plan  and  who  wants  to 
retire  at  age  60,  the  projected 
accumulation  (assuming  COLA 
increases)  is  more  than  $1 .8  million. 


Furthermore,  changes  in  the  IRS 
position  on  plan  amendment  now 
provides  additional  flexibility  should 
the  physician  objectives  change. 

Despite  the  bad  press  over  the 
last  few  years,  the  Defined  Benefit 
Plan  remains  an  important  and 
effective  tax  planning  strategy  for 
physician  small  business.  With  the 
proper  design,  physicians  can 
receive  high  tax  deductions  while 
controlling  the  cost  of  contributions 
for  other  employees. 

Our  thanks  to  Pete  Bernardis  and 
Benetech  for  supplying  us  with  this 
information.  For  further  details 
contact  John  K.  Weisert,  Program 
Director,  Colorado  Medical  Society 
Physician's  Financial  Program,  Chase 
Manhattan  Investment  Services,  Inc., 
2000  S Colorado  Blvd  #8500, 

Denver  CO  80222,  (303)  782-8000 
or  1-800-223-2140. 


Colorado  Medicine  for  February,  1993 


61 


A monthly  report  of 
current  and  on-going 
activities  of  the  Councils , 
Committees  and  Sections 
of  the  Colorado  Medical 
Society.  None  of  the 
information  herein  is 
meant  to  indicate  a policy 
or  position  statement  of 
the  Colorado  Medical 
Society.  This  report  is 
designed  only  to  inform 
CMS  members  of  their 
organization's  activities 
and  study  projects  at  the 
Council , Committee  or 
Section  level. 


The  Committee  on  Accreditation, 
chaired  by  L.  H.  Stahlgren,  MD,  will 

meet  on  February  4 at  4 p.m.  at  the 
CMS  offices. 

The  Council  on  Professional 
Education,  chaired  by  Richard 
Bakemeier,  MD,  will  meet  on 
February  1 8 at  4 p.m.  at  the  CMS 
offices. 

The  Physician  Health  Issues 
Committee,  chaired  by  Bonita  Carson, 
MD,  will  meet  February  1 1 at  5:30 
p.m.  at  the  CMS  offices. 

The  Organizational  Study 
Committee,  chaired  by  John  A. 
Sbarbaro,  MD,  MPH,  will  meet 
February  9 at  5:30  p.m.  at  the  CMS 
offices. 

The  CMS  Education  and  Research 
Foundation  met  January  1 1 and  took 
the  following  actions:  ratified  $5000 
donation  from  ERF  to  CMS  in  support 
of  the  1992  Educational  Program; 
recommended  two  proposed  bylaws 
changes  to  be  presented  to  the  CMS 
Board  for  approval;  approved 
continued  support  of  the  Colorado 
State  Science  Fair  with  a $500 
donation.  The  next  meeting  will  be 
held  April  19  at  Dr.  Rainer's  office. 

The  Coalition  on  Senior  Issues, 
chaired  by  Muryl  Laman,  MD,  will 
meet  March  1 6 at  2:00  p.m.  at  the 
CMS  offices. 


60  Minutes  an 
"excellent  show" 

On  Sunday,  January  24,  1993,  "60 
Minutes"  produced  what  the 
American  Medical  Association 
called  an  "excellent  show"  on  Dr. 
Michael  Carey's  research  at 
Louisiana  State  University  that  was 
halted  through  the  efforts  of  what 
they  called  "animal  'rights'  extrem- 
ists". 

The  AM  A expressed  their  encour- 
agement to  anyone  who  saw  the 
program  to  write  "60  Minutes" 
with  comments.  They  said,  "This  is 
the  first  time  a major  television 
program  has  exposed  the  damage 
caused  by  animal  extremists." 

If  you  wish  to  comment  on  the 
program,  write,  Don  Flewitt,  "60 
Minutes",  524  W.  57th  St,  New 
York,  NY  10019-6101. 

For  another  perspective  on  animal 
research,  see  page  63. 


Reminder  to  all 
Colorado  physicians: 

The  State  Board  of  FHealth  Regula- 
tions say  that  Hepatitis  A — con- 
firmed or  suspected  — is  a manda- 
tory reportable  condition  and  must 
be  reported  within  24  hours  of  clini- 
cal diagnosis,  regardless  of  whether 
or  not  supporting  laboratory  data 
are  available. 

All  physicians,  health  care  provid- 
ers and  hospitals  are  subject  to  these 
regulations. 


62 


Colorado  Medicine  for  February,  1993 


A letter  to  Colorado 
physicians 

I attended  the  November  1 6th 
conference  concerning  animal 
research  sponsored  by  the  American 
Medical  Association,  Colorado 
Medical  Society,  and  the  University 
of  Colorado  Health  Sciences  Center. 
The  conference  was  entitled  "A 
Miracle  at  Risk".  I was  extremely 
disappointed  in  the  program.  It  was 
an  unscientific  presentation  unwor- 
thy of  a professional  organization. 

This  was  not  an  intellectual 
discussion  on  the  pros  and  cons  of 
the  use  of  animals  in  research.  There 
was  no  mention  of  the  fact  that  there 
are  countless  examples  of  useless 
experiments  that  employ  animals. 
There  was  no  mention  of  the  fact  that 
many  animal  experiments  are  useless 
duplications  of  previous  experiments 
and  that  many  experiments  use 
animals  when  other  methods  could 
be  used  sometimes  with  even  greater 
accuracy.  There  was  no  mention  of 
experiments  where  unanesthetized 
animals  are  burned  to  death,  muti- 
lated, electrocuted,  or  drugged  and 
often  left  to  die  a slow  death  over 
several  days  and  all  of  this  frequently 
in  experiments  without  scientific 
merit.  There  was  mention  of  the  fact 
that  there  is  an  Animal  Welfare  Act 
to  protect  experimental  animals,  but 
no  mention  of  the  fact  that  it  does 
not  even  apply  to  most  animals  and 
even  when  it  does  apply  covers  the 
animals  only  before  and  after  the 
experiment  but  does  nothing  to 
protect  them  from  the  horrible  abuse 
during  the  experiment  itself. 

Instead  the  AMA  chose  to  say 
that  animal  research  has  been 
responsible  for  medical  progress  and 


chose  to  say  this  without  giving  any 
facts  to  support  this  controversial 
statement.  They  chose  to  portray 
animal  rights  activists  as  unscientific 
lunatics  and  chose  to  present  animal 
research  as  always  necessary  when 
done  and  seldom  causing  any  pain 
or  discomfort.  They  chose  to  dwell 
on  the  few  examples  where  those 
concerned  with  animal  welfare  have 
broken  into  labs  without  mentioning 
that  these  events  are  rare  and  are 
often  last  resort  attempts  by  those 
who  have  been  frustrated  with  the 
inability  and  disinterest  of  the 
scientific  and  legal  communities  in 
stopping  experiments  that  are  gross 
examples  of  animal  torture  in 
unnecessary  experiments. 

One  of  the  speakers  at  the 
conference  was  Adrian  Morrisson 
who  was  involved  with  defending 
those  accused  of  animal  cruelty  in 
the  Silver  Springs  monkey  experi- 
ments. For  those  who  are  not  familiar 
with  this  legal  case,  these  experi- 
ments were  conducted  by  a behav- 
ioral psychologist,  Edwin  Taub,  who 
cut  the  nerves  to  one  arm  of  each 
monkey  in  an  attempt  to  duplicate 
the  effects  of  a stroke.  After  the 
operation  the  monkeys  were  pre- 
vented from  using  their  good  limb  to 
see  how  they  managed  with  the 
other  arm.  The  lab  itself  was  a hell 
on  earth  with  rusty  cages  with  moldy 
excrement  and  the  monkeys  left  with 
draining  wounds  and  limbs  with 
stumps  where  there  had  once  been 
fingers.  I would  seriously  question 
the  ethics  of  anyone  who  would 
defend  these  experiments. 

Another  speaker  was  Nora 
Rumpf  who  presented  the  story  of 
her  son  who  she  said  was  cured 
because  of  a procedure  developed 
by  animal  researchers.  There  was  no 


discussion  of  exactly  how  the 
animals  had  helped  to  developed 
this  procedure.  Most  importantly  a 
personal  testimonial  of  one  case  by  a 
medically  untrained  person  does  not 
have  a place  in  any  supposedly 
scientific  meeting. 

The  next  speaker  was  James 
Stevens,  DVM  who  is  the  Director  of 
Laboratory  Animal  Resources  at  the 
University  of  Colorado.  His  topic 
was  animal  rights  in  Colorado.  He 
listed  the  animal  rights  groups  in  this 
state.  He  also  gave  out  the  names  of 
the  heads  of  two  of  the  organizations 
both  of  whom  I know  personally  and 
can  attest  to  their  kind  nature  and 
tireless  work  to  lessen  animal  cruelty 
in  this  community.  Dr.  Stevens 
continued  by  listing  other  what  he 
felt  were  ridiculous  things  that  the 
animal  rights  groups  were  working 
on  such  as  veal  farming,  the  fur 
industry,  and  conditions  in  slaughter 
houses.  I question  the  ability  of 
anyone  to  head  up  the  animal  labs  at 
the  University  of  Colorado  who  does 
not  know  about  or  have  compassion 
for  the  animal  abuse  involved  in 
these  industries. 

Overall  I found  the  conference 
to  be  a one-sided  unscientific 
propaganda  show.  There  was  no 
serious  discussion  of  any  of  the 
crucial  issues  involved  with  the  topic 
of  animal  use  in  research.  The 
conference  was  an  insult  to  anyone 
of  intelligence  and  a devastation  to 
anyone  with  compassion.  As  long  as 
the  medical  profession  continues  to 
turn  its  back  on  animals  who  suffer 
needlessly  then  the  public  will  view 
the  medical  profession  with  mistrust 
and  misgivings. 

Peggy  Carlson,  M D 

St.  Anthony  North  Hospital 


Colorado  Medicine  for  February,  1993 


63 


Book  Review 


"Aids  in  the  World,  A Global  Report" 

Harvard  University  Press  1992.  843  pages.  $19.95  (U.S.) 


By  Thomas  H.  Coleman , MD. 

Denver 


" The  behavior  of  nations 
invites  the  virus , 
the  behavior  of  people 
does  not  change 


This  book  is  a tremendous 
accomplishment.  It  is  required 
reading  for  anyone  who  is  not  afraid 
of  realities  and  professes  to  have 
more  than  a superficial  understand- 
ing of  the  AIDS  epidemic.  It  collects 
in  one  place  the  facts  about  the 
worldwide  behavior  of  the  AIDS 
virus  while  it  is  infiltrating  and  killing 
the  human  race.  As  a story  it  is 
fascinating  and  frightening.  As  a 
primary  reference  it  is  indispensable 
to  an  understanding  of  what  the 
medical  professions  and  the  people 
of  the  world  are  facing. 

The  book  has  unusual  scientific 
credentials.  It  is  not  the  child  of 
political  prejudice  or  money.  It  is 
privately  funded  by  the  Francois- 
Xavier  Bagnoud  Foundation.  In  1991 
the  Foundation  organized  the  Global 
AIDS  Policy  Coalition,  committed  to 
tracking  and  evaluating  the  AIDS 
pandemic.  This  book  is  the 
Coalition's  first  report.  Its  editors, 
advisors  and  contributors  come  from 
the  medical  schools  of  Michigan, 
FHarvard,  Yale,  and  from  other 
experts  on  the  scene  in  seventeen 
nations,  Australia  to  Zimbabwe.  The 
report  brings  a message  too  grave  for 
review  as  just  another  medical  book. 
Some  of  the  particulars: 

In  fewer  than  twenty  years  of  the 
world  epidemic  HIV  has  infected 
about  13  million  people.  It  has  killed 
two  and  a half  million.  By  1 995  it 
will  have  infected  about  7 million 
more.  Nearly  20  percent  of  those 
will  be  children. 

In  the  five  years  between  1 995 
and  2000  the  virus  will  infect  six 
times  more  adults  than  it  did  in  its 
first  twenty  years.  A conservative 
projection  for  the  year  2000  sees  a 


total  of  at  least  38  million  adults 
infected.  A more  realistic  figure  is 
probably  near  100  million. 

The  virus  is  riding  high  on 
mindless  sexual  drives,  thriving  on 
international  complacency,  igno- 
rance, superstition,  misinformation., 
discrimination,  and  denial.  Individu- 
als, societies  and  nations  think  AIDS 
is  a sexual  disease  of  "other  people", 
other  groups  and  nations.  Since  they 
don't  "belong"  to  those  groups  they 
think  they're  not  at  risk  whilethey  are 
easily  the  next  victims. 

The  virus  is  constantly  shifting 
among  all  classes  of  world  society 
regardless  of  geography.  It  is  growing 
in  the  "low  intensity"  wars  of 
Yugoslavia,  Angola,  Liberia.  The 
people,  especially  children,  flee  their 
villages  for  the  refugee  camps  and 
the  streets  of  cities  where  they  have 
no  money,  no  food,  and  no  protec- 
tion against  drugs,  prostitution  and 
abuse. 

The  behavior  of  nations  invites 
the  virus,  the  behavior  of  people 
does  not  change.  In  the  late  1970s 
Tanzania  dosed  its  borders,  attract- 
ing young  Tanzanian  smugglers. 

They  were  infected  by  the  virus  from 
Uganda.  As  they  began  to  die  they 
blamed  the  disease  on  a fast-selling 
red  shirt  smuggled  from  other 
countries.  Tanzanian  men  decided 
that  the  shirts,  printed  with  an  eagle 
and  the  word  "Juliana",  must  be 
cursed  by  witchcraft.  They  named 
the  disease  Juliana.  When  Juliana's 
victims  lost  weight  and  became  slim, 
they  called  it  "slim".  This  caused  a 
"logical"  change  in  behavior.  The 
men  avoided  thin  prostitutes.  They 
thought  the  plump  ones  would  be 
"safe". 


64 


Colorado  Medicine  for  February,  1993 


"In  Mexico  City  in  1 984  only  one  woman  was  infected  for  every  25  men. 

By  1990  the  ratio  was  1 in  4." 

"No  nation  is  without  ignorance 


This  worldwide  holocaust  has 
not  been  arrested  by  provincial 
programs  crippled  by  politicians  and 
bureaucrats.  Out  of  fear  and  denial 
the  heads  of  state  in  1 3 of  35  coun- 
tries still  have  made  no  public 
mention  of  AIDS  as  a problem. 
Thirteen  others  had  never  mentioned 
it  until  1 989.  In  some  of  those 
countries  twenty  to  thirty  percent  of 
the  people  already  are  infected, 
waiting  to  die. 

Prevention  by  education  is  the 
only  hope  for  slowing  the  rate.  The 
most  vulnerable  groups  are  also  the 
most  unreachable,  both  intellectually 
and  logistical ly.  Money  has  not  done 
it.  Money  spent  per  capita  for 
prevention  in  North  America,  Europe 
and  Australian  Oceania  averages 
about  $2.  In  sub-Saharan  Africa,  with 
68  percent  of  the  world's  HIV 
infection,  it  is  about  five  cents.  In 
England  some  of  the  first  educational 
literature  was  censored  and  sup- 
pressed as  "obscene".  In  the  United 
States  about  8 percent  of  the  people 
at  risk  could  not  read  well  enough  to 
understand  the  literature. 

Industrialized  nations  don't  fund 
prevention  worldwide  because  they 
see  AIDS  as  a "problem  of  the 
developing  countries".  The  Coalition 
calls  upon  world  leaders  for  a 
"global  ethic  of  caring",  in  the  name 
of  self-protection  and  national 
survival. 

As  the  infection  rises,  world 
response  weakens.  In  1991  the  world 
cost  of  care  for  people  with  AIDS 
was  $3.5  billion,  twice  the  cost 
estimated  for  prevention.  In  several 
nations  the  cost  of  care  for  people 
with  AIDS  will  eventually  equal  the 
gross  national  product. 


Meanwhile,  infected  travelers  fly 
the  world,  with  their  AIDS  and 
tuberculosis  "carry-on",  to  start  little 
epidemics  in  every  island,  every 
nation.  Infected  commercial  sex 
workers  welcome  travelers  who  are 
not  yet  infected.  ("CSWs"  is  the  new 
acronym  for  prostitutes).  The  virus 
comes  home  to  towns  and  families 
where  it  probes  into  every  vulnerable 
person,  every  innocent  group. 

This  brings  cries  for  selective 
testing,  or  closure  of  international 
borders.  There  are  too  many  false 
tests,  too  many  threats  to  privacy, 
freedom  and  tourism  to  make 
programs  of  massive  testing  practi- 
cable. An  Illinois  law  requiring 
premarital  testing  was  followed  by  a 
decline  of  22  percent  in  marriage 
license  applications.  Among  1 55,000 
applicants  tested,  Illinois  discovered 
the  virus  in  26  people  at  a cost  of 
$208,000  each. 

The  virus  is  equalizing  men  and 
women.  In  Mexico  City  in  1984  only 
one  woman  was  infected  for  every 
25  men.  By  1990  the  ratio  was  1 in 
4. 

During  1989-90  in  Bombay's 
sexual  disease  clinics  the  HIV 
infection  rate  was  4.3  percent.  By 
1991  it  was  32  percent. 

HIV  is  slowly  killing  young 
families,  robbing  their  countries  of 
entire  generations,  destroying  the 
workers,  converting  them  to  a 
human  loss  and  a financial  burden. 

AIDS  is  potentially  worse  than 
the  plague  that  swept  away  most  of 
the  labor  force  of  Europe  in  the 
fourteenth  century,  worse  than  the 
influenza  pandemic  that  killed 
millions  in  a few  months  of  191  8-1  9. 
A vaccine  may  be  on  the  horizon  in 


scientific  laboratories,  but  testing, 
approval  and  distribution  would  take 
years.  Small  groups  of  volunteers, 
(ASOs  or  AIDS  Service  Organiza- 
tions) and  straightforward  dramas  in 
the  mass  media  are  slowly  influenc- 
ing the  sexual  customs  of  people  at 
risk,  beginning  to  educate  govern- 
ments about  prevention. 

At  the  same  time  the  press  in  one 
industrialized  country  quotes  a 
notorious  personality  who  says  AIDS 
is  a racial  conspiracy  designed 
intentionally  to  decimate  minorities. 
No  nation  is  without  ignorance. 

We  await  the  Coalition's  report 
for  1993. 


Colorado  Medicine  for  February,  1993 


65 


Colorado  Medical  Society  offices 
were  the  site  of  a brief  demonstration 
by  a group  representing  ADAPT 
(Americans  Disabled  for  Attendant 
Programs  Today)  on  January  1 5th. 
ADAPT  spokesperson,  Wade  Blank, 
said  the  group  was  mainly  con- 
cerned that  the  American  Medical 
Association  know  of  its  protest  to 
Colorado  doctors  over  current 
funding  of 
nursing  homes. 
Blank  said 
ADAPT  is  asking 
"for  no  new 
funding.  We  are 
asking  that  25% 
of  the  Medicaid 
funding  which 
now  goes  to 
nursing  homes 
be  redirected  to 
fund  a national 
community- 
based  attendant 
service  pro- 
gram." Blank 
added  that 
ADAPT  came  to  CMS  because  it 
mainly  wanted  input  into  a group 
representing  a majority  of  Colorado's 
doctors.  Blank  also  said  his  group 
wants  the  AMA  to 

• direct  its  members  to  reduce 
nursing  home  referrals  by  50%  in 
the  first  year 

• require  all  member  physicians  to 
make  full  disclosure  of  their 
financial  interests  in  nursing  homes 
and  institutions 

• mandate  that  AMA  members  divest 
themselves  of  all  financial  interests 
in  nursing  homes  and  institutions, 
and 

• invite  ADAPT  to  present  at  the  next 


national  AMA  conference  and  vote 
on  ADAPT's  resolution. 

CMS  President-elect  Wm.  Carl 
Bailey,  MD,  was  the  officer  on 
location  this  particular  day.  He  and 
Executive  Director  Sandi  Maloney 
conferred  with  the  group,  first 
listening  to  their  requests  and  their 
demands,  then  responding  with  a 
reasoned  approach  of  inviting 
ADAPT  representatives  to  present 
their  points  before  CMS  councils  or 
committees..  Wade  Blank  asked  if 
CMS  had  a committee  or  task  force 
studying  the  Governor's  health  care 
reform  proposals  and,  if  so,  could 
ADAPT  have  input  to  that  group?  Dr. 
Bailey  said  he  felt  that  was  a reason- 
able request  and  one  which  could  be 
arranged.  Sandi  Maloney  said  she 
would  act  as  the  liaison  for  CMS  and 
would  set  such  an  agenda. 

Bailey  asked  if  there  were  any 
other  points  and  a spokesperson  said 
the  group  wanted  someone  in  the 
CMS  office  to  call  the  AMA  (now) 
and  tell  them  what  was  taking  place 
here  in  Denver  and  what  their 
(ADAPT's)  requests  were,  because 
Colorado  was  only  one  of  1 5 state 
societies  that  were  being  visited  by 
ADAPT  demonstrators  on  January 
1 5th.  Wade  Blank  said  his  group  had 
a meeting  with  AMA  representatives 
at  the  Interim  Meeting  in  Nashville, 
telling  them  they  wanted  positive 
answers  to  the  ADAPT  demands  by 
this  date  or  demonstrations  were  in 
the  offing. 

When  a CMS  staffer  began 
taking  video  pictures  of  the  group,  a 
number  of  demonstrators  said  they 
did  not  want  pictures  because  they 
were  afraid  they  would  be  used 
against  the  individuals.  Sandi 


66 


Colorado  Medicine  for  February,  1993 


Demonstrators  come  to  CMS  offices 


Maloney  replied  that  it  was  a CMS 
employee  taking  the  pictures.  Dr. 
Bailey  was  quick  to  remind  the 
demonstrators  that  if  they  wanted  a 
fair  representation  to  the  entire  CMS 
organization,  then  they  had  better 
allow  the  video  recording. 

The  group  continued  to  protest 
the  picture-taking,  saying  that 
television  news  men  had  not  been 
allowed  into  the  building  to  take 
pictures  for  the  public  news  media, 
so  CMS  should  not  be  allowed  to 
either.  Dr.  Bailey  was  quick  to  pick 
up  on  the  issue,  replying:  "Wait  a 
minute.  You  came  here  unan- 
nounced and  marched  into  our 
offices  and,  I can  say,  disrupted 
things.  When  we  try  to  explain  this 
to  our  members,  I think  the  recording 
and  pictures  will  be  helpful."  ADAPT 
then  replied:  "It  would  have  been 
nice  if  Channel  4 could  have  come 
up  and  filmed  it  for  the  general 
public."  Dr.  Bailey  replied,  "Well, 
now  I didn't  think  Channel  4 was  the 


issue  here  today. 
If  it  is,  then  we 
have  no  more  to 
talk  about." 

The  demon- 
stration lasted 
for  a little  less 
that  two  hours. 
Both  sides  went 
away  feeling 
they  had  a better 
perspective  of 
one  another's 
position.  CMS 
will  follow  up 
on  its  pledge  to 
open  communi- 
cation channels 
and  allow  input  from  the  group. 

Dr.  Bailey  said  to  CMS  staff  later, 
"There's  no  doubt  this  kind  of  protest 
will  occur  more  frequently  as  the 
health  care  question  becomes  more 
the  focal  point  of  public  concerns. 
CMS  will 
remain  on 
the  front 
line  and 
be 

targeted 
by  other 
such 
demon- 
strations." 


Photos  captured  from  videotape  with  Macintosh  llsi  computer 
and  MacVision  image  capturing  hardware  and  software. 


Colorado  Medicine  for  February,  1993 


67 


* mi 


Q 

kJt 


"alt  Lake  City  has  a lot  to 
| offer,  from  world-class 
theater  to  the  Utah  Sym- 
phony — one  of  the  nation's 
top  ten  orchestras.  And  as  a 
physician  with  FHP,  you  can 
actually  take  advantage  of  it. 
Our  predictable  schedules  give 
you  time  that  is  truly  your  own. 
For  a multitude  of  cultural  and 
recreational  activities  — or  just 
simple  relaxation.  And  that's 
not  all. 

At  FHP,  you  won't  have  book- 
keeping headaches,  the  hassles 
of  staffing  an  office  or  worries 
about  malpractice  insurance. 
You're  free  to  focus  on  what 
you  really  enjoy:  practicing 
high-quality  medicine. 

Find  out  more  by  calling  1 -800- 
283-8884,  ext.  631 . Or  send 
your  C.V.  to  FHP,  Professional 
Staffing,  35  West  Broadway, 
Salt  Lake  City,  UT  841 01 -9933. 
Opportunities  also  available 
in  AZ,  CA,  NM  and  Guam.  An 
equal  opportunity  employer. 


the  time  to 


— • Christine  Petersen,  M.D. 


Giving  Physicians  More 
of  What  They  Want. 


FHP 

HEALTH  CARE 


mm 


BE  AN  AIR  FORCE 
PHYSICIAN. 

Become  the  dedicated  physician  you 
want  to  be  while  serving  your  country  in 
today’s  Air  Force.  Discover  the  tremen- 
dous benefits  of  Air  Force  medicine.  Talk 
to  an  Air  Force  medical  program  manag- 
er about  the  quality  lifestyle  and  benefits 
you  enjoy  as  an  Air  Force  professional, 
along  with: 

• 30  days  vacation  with  pay  per  year 

• Dedicated,  professional  staff 

• Non-contributing  retirement  plan  if 
qualified 

Today’s  Air  Force  offers  the  medical  envi- 
ronment you  seek.  Find  out  how  to  quali- 
fy Call  To||  Free  usAF  Health  Professions 
1-800-423-USAF 


68 


Colorado  Medicine  for  February,  1993 


M E L 


Dr.  John  C.  Seiner 
elected  ACAI 
President 

In  December 
of  1 992  the 
American  College 
of  Allergy  and 
Immunology 
(ACAI)  elected 
John  C.  Seiner, 
MD.  as  President. 
Dr.  Seiner  has 
been  a member  of  the  Colorado 
Medical  Society  for  the  past  27 
years. 

In  addition  to  private  practice  in 
Allergy/Respiratory,  Dr.  Seiner  is 
Director  of  the  Allergy  Respiratory 
Institute  of  Colorado,  Clinical 
Professor  in  the  Department  of 
Medicine,  at  Children's  Hospital, 
Denver,  1976-92,  and  Founder  and 
Director  of  the  Environmental  Care 
Unit  at  Presbyterian  Hospital,  1979- 
82. 

Dr.  Seiner  has  authored  numer- 
ous articles  in  the  medical  literature 
and  contributed  chapters  in  several 
medical  text  books.  He  is  a contrib- 
uting editor  to  several  medical 
journals,  including  Annals  of  Allergy, 
New  England  and  Regional  Allergy 
Proceedings,  Pediatric  Allergy,  and 
Rhinology. 

The  Colorado  Medical  Society 
wishes  success  to  Dr.  Seiner  as 
President  of  ACAI. 

Three  Public  Health 
Scholars 

Randy  Gordon,  MD,  director  of  the 
Weld  County  Health  Department, 


Christine  Nevin-Woods,  MD, 

director  of  the  Pueblo  City-County 
Health  Department  and  John  Muth, 
MD,  Director  of  the  El  Paso  County 
Department  of  Health  and  Environ- 
ment, have  been  selected  to  serve  as 
Scholars  for  the  second  annual 
national  Public  Health  Leadership 
Institute. 

The  institute  is  funded  by  the 
Centers  for  Disease  Control  and 
serves  to  strengthen  America's  public 
health  system  by  enhancing  the 
leadership  capacities  of  city,  county 
and  state  health  officials. 

"Being  chosen  an  Institute 
Scholar  is  certainly  a tremendous 
honor."  said  each  of  the  three 
physicians.  Each  spoke  of  a commit- 
ment to  using  this  opportunity  to 
further  their  work  in  addressing  the 
complex  health  challenges  in  their 
local  health  departments  and  in  the 
nation. 

Veterans  Alert 

Veterans  who  served  in  China, 
Burma,  and  India  in  World  War  II 
are  invited  to  a reunion,  August  1 1- 
1 5,  1 993,  in  Salt  Lake  City,  Utah. 

This  46th  annual  reunion  is  being 
organized  by  the  China-Burma-India 
Veterans  Association,  which  has  over 
7000  members. 

As  stated  by  Homer  C.  Cooper, 
Organizer  of  the  CBI  annual  re- 
unions, "Although  the  national 
China-Burma-India  Veterans  Asso- 
ciation has  over  7,000  members  and 
has  held  reunions  annually  since 
I 948.  I can't  help  but  feel  that  we 
have  failed  to  find  thousands  of  CBI 
veterans  who  would  enjoy  our 
reunions  if  they  knew  about  them." 

If  you  are  a CBI  veteran,  please 


send  your  name,  address,  and  phone 
number  to  Homer  C.  Cooper,  145 
Pendleton  Drive,  Athens,  Georgia 
30606,  so  they  can  send  you  infor- 
mation about  the  reunion.  Please 
also  tell  them  the  name  of  your  CBI 
unit  and  the  locations  where  you 
served  overseas. 

If  you  cannot  attend  the  Salt 
Lake  City  reunion,  they  would  still 
like  to  hear  from  you  so  we  can 
notify  you  of  future  CBI  programs, 
including  those  of  local  CBIVA  units 
in  your  state. 

Recognizing 

Inventors 

The  American  College  of 
Physician  Inventors  (ACPI)  proudly 
announces  its  incorporation  with  the 
motto  "Creatrex  Medicus  Pro  Ingenio 
Suo  Noscatur"  Let  the  Creative 
Physician  Inventor  be  Recognized  for 
His  Genius. 

ACPI  is  a new  organization  that 
has  been  formed  by  a prestigious 
group  of  physician  inventors  to 
establish  a forum  for  creative  profes- 
sionals and  to  assist  in  the  inventing, 
patenting  and  marketing  process  of 
ideas  applicable  to  the  medical 
profession.  They  also  acts  as  a liaison 
between  physician  inventors,  the 
medical  community,  industry  and 
the  government  regulatory  agencies. 

The  ACPI  was  founded  this  past 
spring  of  1992  by  Leo  Rubin,  MD  , 
Herb  Dardik,  MD  , Frank  Deber- 
nardis  and  Charles  Klieman,  MD. 

For  further  information  contact: 
Frank  Debernardis  at  352  Hillcrest 
Road  , Ridgewood,  N.J.  07450, 
phone  (201 ) 447-6926  or  Charles 
Klieman,  MD  at  (310)  698-0271 . 


Colorado  Medicine  for  February,  1993 


69 


Medical 


News 


HEALTH 

WORKBOOK 

The  Colorado  Department  of 
Health  STD/AIDS  Section  has 
compiled  a free  resource  workbook 
for  persons  with  HIV  infection.  The 
workbook  is  designed  to  help  health 
care  professionals  provide  better  HIV 
risk-reduction  counseling,  emotional 
support  and  referral  to  community 
resources.  The  workbook's  aim  is  to 
empower  individuals  to  take  and 
active  role  in  their  health  care,  stay 
healthier  longer  and  prevent  the 
transmission  of  HIV  infection.  The 
workbook,  adapted  from  materials 
developed  by  the  Seattle-King 
County  AIDS  program,  has  chapters 
on  such  topics  as  emotional  reac- 
tions to  HIV  infection,  disclosure  and 
partner  notification,  stress,  nutrition, 
safer  sex,  HIV  infection  in  women, 
drugs  and  alcohol,  TB  and  hepatitis 
B and  legal  and  financial  assistance. 
Attachments  include  listings  of 
clinical,  dental  and  mental  health 
referrals,  community  support  ser- 
vices, social  services  and  social 
security  offices,  local  health  depart- 
ments and  community  nursing 
services.  The  free  workbook  can  be 
obtained  by  contacting  Judith 
Schwartz  at  (303)  692-2707  or 
writing  to: 

Colorado  Department  of  Health 

DCEED-STD-A3 

4300  Cherry  Creek  Drive  South 

Denver,  CO  80222-1530 

New  DEA  Numbers 

During  the  past  year,  the  Drug 
Enforcement  Administration  has 
undergone  relocation.  The  new  local 


as  well  as  national  address  and 
telephone  numbers  are  as  follows: 

1 1 5 Inverness  Drive  East 
Englewood,  Co.  801 1 2 
(303)  784-6300 
For  registration  information: 

(303)  784-6323 
National: 

Drug  Enforcement 
Administration 
700  Army  Navy  Drive 
Arlington,  VA  22102 
(202)  307-1000 

Diabetes  Patients 
Needed 

The  International  Diabetes 
Center  of  Colorado  (IDC)  is  seeking 
volunteers  for  a research  study 
Participants  will  help  test  a new 
insulin.  This  new  insulin  may  act 
more  quickly  in  lowering  blood 
sugar  with  less  risk  of  low  blood 
glucose  reactions.  The  study  will  last 
one  year. 

Volunteers  for  the  study  must: 

- Have  Type  II  diabetes. 

- Need  insulin  to  control  their  blood 
sugar  and  have  been  advised  by  a 
physician  to  switch  from  an  oral 
agent  to  insulin  to  control  blood 
sugar. 

- Men  and  women  between  the  ages 
of  35-85  years  old. 

- Only  women  of  non  child-bearing 
potential  can  participate,  or  women 
practicing  birth  control  can  partici- 
pate. 

- No  hepatitis,  kidney,  cancer  or 
chronic  debilitating  disease. 

For  more  information  call 
Honora  Caldwell,  IDC  of  Colorado 
at  (303)425-851  1. 

December  30,  1 992 


Radiation  Data 
Needed 

An  open  letter  to  all  Colorado 
Physicians: 

Our  research  group  is  in  the 
process  of  accumulating  data  on  the 
human  health  effects  of  nonionizing 
electromagnetic  frequencies  in  the 
range  between  electric  power 
transmission  frequencies,  and 
microwave  frequencies. 

Although  there  has  been  a great 
deal  of  interest  and  research  on  this 
subject,  the  information  available  on 
the  human  health  effects  of  this 
radiation  does  not  permit  us  to 
conclude  that  there  are  serious 
health  effects. 

We  believe  there  is  an  increase 
in  awareness  of  both  physicians  and 
patients  that  nonionizing  electromag- 
netic radiation  may  have  some 
human  health  effects,  with  the  most 
prominent  being  links  to  neoplastic 
disease.  Of  specific  interest  to  us  is 
the  potential  for  collecting  cases  or 
clusters  of  cases  recognized  by 
practicing  physicians  in  the  United 
States,  which  may  be  related  to 
exposure  to  Nonionizing  Electromag- 
netic Radiation. 

We  would  be  interested  in 
hearing  from  any  physicians  or 
physician  groups  that  may  have 
experience  with  this  problem. 

Please  contact  : The  NATIONAL 
REGISTRY  for  the  HEALTH  EFFECTS 
of  NONIONIZING  RADIATION 

300  Tollgate  Rd. 

Warwick,  R.l.  02886 

(401)  732-4900 


70 


Colorado  Medicine  for  February,  1993 


Classified  Advertising 


Publication  of  any  advertisement  in  Colorado  Medicine  is  not  an  endorsement  by  the  Colorado  Medical  Society 
of  the  product  or  service.  Colorado  Medicine  magazine  is  the  official  journal  of  the  Colorado  Medical  Society , and 
is  authorized  to  carry  General  Advertising. 


♦ PROFESSIONAL  OPPORTUNITIES 


O'CONNOR  & ASSOCIATES— Medical 
Management  Consulting.  Services 
include:  free  initial  consultation, 
financial,  personnel  and  contract 
management;  planning&  implementing. 
William  J.  O'Connor,  PhD,  7436  S. 
Clarkson  Cir.  Littleton,  CO  801 22  (303) 
797-861 1 3/0293 


BC/BE  DIAGNOSTIC  RADIOLOGY— 
Immediate  opening  for  Diagnostic  Rad- 
iologist with  skills  in  MRI  & Interventional. 
Join  a growing  3-4  physician  practice  in 
1 00  bed  community  hospital  45  miles  north 
of  Denver.  Attractive  compensation 
package  with  track  to  partnership.  Send  CV 
to  Donald  Cornforth,  MD,  P.O.  Box  238, 
Loveland,  CO  80539  or  contact  Sharon  at 
(303)669-7916.  4/1192 

GENERAL  SURGEON  needed  to  join 
compatible  staff,  small  VA  medical  center 
in  Cheyenne,  WY.  Laparoscopic,  vascular/ 
thoracic  surgery  beneficial.  Competitive 
salary/benefits.  Ideal  location  with  varied 
recreational  activities  — hunting,  fishing, 
skiing  and  camping.  2 hrs  from  Denver. 
CME  opportunities,  theater,  arts  and 
professional  sports.  Affiliation  with  U of 
Colorado  possible.  Local  community 
college.  U of  Wyoming  only  1 hr  away. 
Excellent  public  education  system,  low 
crime,  low  cost  living  — no  state  income 
tax.  Send  CV/resume  to  Mike  Lee  (11  A), 
VA  Medical  Center,  2360  E Pershing  Blvd, 
Cheyenne  WY  82001,  or  call  (307)  778- 
7307.  4/1192 

LOCUM  TENENS  COVERAGE  and  Op- 
portunities in  the  greater  Denver  area: 
CompHealth,  the  nation's  premier  locum 
tenens  organization,  now  provides  daily, 
weekly,  weekend,  evening,  or  monthly 
coverage  for  your  practice  with  physicians 
from  the  local  area.  Or  we  offer  you  the 
opportunity  to  build  a flexible  practice 
right  in  the  Denver  area.  Call  today  for 
more  information,  (303)  777-8002,  or  write, 
P.O.  Box  100218,  Denver  CO  80250.1  2/ 
1092 


EMERGENT/URGENT  CARE  PHYSICIAN 
Full  and  part  time  position  in  Lafayette. 
Flexible  scheduling.  Send  CV  or  Contact 
Dr.  Coryell,  Community  Medical  Center, 
2000  W.  S.  Boulder  Rd.,  Lafayette,  CO 
80206,  (303)  666-4357.  1 2/0892 

FAMILY  PRACTICE  OPPORTUNITY  IN 
CANON  CITY 

We  need  one  family  physician  to  practice 
in  the  Climate  Capital  of  Colorado. 
Privileges  at  St.  Thomas  More  Hospital, 
obstetric  services  desirable  but  not  requ  ired. 
Unlimited  opportunities  for  recreation. 
Growing  community.  For  more  information, 
please  call  or  write  Gary  Alan  Mohr,  MD, 
FAAFP,  730  Macon  Avenue,  Canon  City, 
CO  81212,  (719)  275-1618  Tfn/0892 


LOCUM  TENENS It  is  not  what  it  used 

to  be.  As  a client,  your  practice  goes 
uninterrupted.  As  a locum  tenens,  you  have 
the  freedom  and  flexibility  to  work  as  often 
or  as  little  as  you  like.  Physician  managed 
since  1982.  Call  for  details — Interim 
Physicians  1 -800-669-071  8 or  (303)  691  - 
0718.  12/0192 

EXPERIENCED  ANESTHESIOLOGIST 
preparing  for  oral  board  exam  in  April 
1993.  Desires  part  time  or  low-volume 
practice  or  Locum  Tenens.  Contact  David 
Murphy,  MD.  4 Middle  Rd.  Englewood, 
CO  80110.  (303)  753-1819.  3/1292 


Practice  Made  Perfect. 


If  you  would  like  to  find  the  ideal  balance  between  private  practice  and 
managed  health  care,  Lutheran  Medical  Centers  of  Colorado,  an  affiliate 
of  Lutheran  Medical  Center,  has  the  setting  for  you. 

Working  within  our  network  of  7 family  practice  and  occupational 
medical  facilities,  you'll  experience  the  challenge  and  professional 
autonomy  of  your  own  private  practice.  At  the  same  time,  you'll  enjoy 
the  benefits  of  regular  hours,  no  on-call,  guaranteed  compensation  and 
minimal  administrative  duties.  We  also  provide  strong  support  and 
attractive  incentives  for  you  to  build  the  practice.  It's  the  perfect  environ- 
ment for  you  to  do  what  you  do  best  — practice  medicine. 

In  addition,  Colorado  offers  the  perfect  environment  for  a great  life  away 
from  work.  Breathtaking  surroundings,  affordable  housing  and  a wealth 
of  recreational  and  cultural  activities  await. 

If  you're  a board-certified  physician  and  you'd  like  to  give  your  practice  a 
new  dimension,  please  call  1-800-677-6562,  fax  resume/ 

M letter  of  interest  to  (303)  425-4019,  or  write  Human 

Resources,  Dept.  CM,  8300  W.  38th  Avenue, 

^ Wheat  Ridge,  CO  80033.  EOE. 


Colorado  Medicine  for  February,  1993 


71 


lassified  Advertising 


FAMILY  PRACTICE— HOSPITAL  SPON- 
SORED  CLINIC  OPPORTUNITY.  Dynamic, 
growth  oriented  hospital  in  beautiful  North 
Central  Wisconsin  is  seeking  Family 
Physicians  to  respond  to  growing  com- 
munity demand.  The  administrative  burdens 
of  medical  practice  will  be  minimized  in 
this  hospital  managed  clinic.  The  hospital 
has  committed  to  an  income  and  benefit 
package  which  is  significantly  higher  than 
similar  opportunities.  Package  includes 
base  income,  incentive  bonus,  malpractice, 
disability,  signing  bonus  and  student  loan 
reduction/forgiveness  program.  All  reloc- 
ation costs  will  be  borne  by  the  hospital. 
Please  contact  Kari  Wangsness,  Associate, 
The  Chancellor  Group,  Inc.,  France  Place, 
Suite  920,  3601  Minnesota  Drive, 
Bloomington,  Minnesota,  55435,  (612) 
835-5123.  tfn/1190 

FAMILY  PHYSICIAN  needed  full  time  to 
practice  in  great  Lakewood  location.  Duties 
include  family  practice  medicine  excluding 
OB  and  inpatient  hospital  work.  Four 
physician  call  group.  Excellent  comp- 
ensation package.  Please  contact  Shirley 
Lewis,  Porter  Hospital,  (303)  778-5691 .2/ 
1292 

LOCUM  TENENS...  new  adventures,  free 
from  administrative  tasks,  flexibility , and 
high  earnings.  Assignments  vary:  one  day, 
one  week,  one  month,  longterm,  OR,  time 
off  with  peace  of  mind,  knowing  that  your 
practice  goes  uninterrupted.  Qualified 
physicians  are  ready  to  assist.  Ten  years 
experience;  physician-managed  company. 
Call  INTERIM  PHYSICIANS  today  for 
details. — Denver691  -071 8,  or  1 -800-669- 
0718  12/1292 

UROLOGY  PRACTICE  OPPORTUNITY  in 
South  Central  Colorado.  Western  com- 
munity at  edge  of  Rocky  Mountains  offers 
clean  environment,  quality  of  life,  easy 
access  to  larger  communities.  Group 
Practice.  Hospital  pays  interview  and 
relocation  expenses.  Offers  financial 
support  for  selected  candidate  for  a period 
of  time.  Call  collect:  Willim  Foster,  CEO 
(71 9)  269-2021  or  269-9305.  2/1  292 


COLORADO  MTN.  RESORT  PRACTICE 
FOR  SALE.  Busy  OB.  GYN.  practice  in  the 
ski/summer  resort  of  Steamboat  Springs. 
Available  to  BC/BE  physician.  Retiring 
physician  will  transition  practice  which 
offers  excellentfinancial  return  inabeautiful 
mountain  community.  Good  OB.  and  GYN 
call  coverage.  Please  send  C.V.  to  : Box  T. 
C/O  Colorado  Medical  Society,  P.O.  Box 
1 7550,  Denver,  CO.  8021  7-0550  3/0193 

TIRED  OF  THE  DAY  TO  DAY  HASSLE  of 

HMO's,  Medicare,  discounted  insurance 
and  being  on  cal  I (Then  consider  a position 
with  corrections.  Before  you  say  "No  Way," 
call  us  and  find  out  more.  Contact  Roderic 
Gottula,  MD,  10900  Smith  Road,  Denver, 
CO  80239  or  call  (303)  375-2110.6/0193 

WANTED:  OPEN-MINDED  GENERAL 
PRACTITIONER  to  perform  evaluations  in 
multi-specialty  office.  Part  time,  flexible 
hours,  hourly  rate.  Call:  721  -7947  and  ask 
for  Dr.  K. 

BOULDER- AMBULATORY  CARECLINIC- 
Family  Medicine/Emergent  Care/Occu- 
pational Medicine  - Busy,  two  physician 
practice  seeking  full  time  BE/BC  Family 
Practitioner  to  join  growing  comprehensive 
medical  practice  in  prime  SE  Boulder  area. 
New,  well  equipped  facility.  Minimal  call. 
Flexable  scheduling.  Send  CV  and  call  Dr. 
Turnbow,  4800  Baseline,  D-106,  Boulder, 
Co  80303  (303)  449-4800.  3/0293 

DIAGNOSTIC  RADIOLOGY  POSITION, 
CRAIG,  CO.  1 st.  Yr.  1 1 0k,  Benefits,  6 weeks 
off:  2nd  Yr.  120k,  Benefits,  8 weeks  off. 
Equal  shares  thereafter.  Reply;  Royal  Smith, 
MD.  Memorial  Hosp.  785  Russell  St.  Craig, 
Co.  81 625  or  call  (303)  945-6535  ext.  312, 
Days  or  945-8296  evenings.  3/0293 

PHYSICIANS,  SURGICAL/ANESTHES- 
IOLOGY RESIDENTS,  (MD/DO).  Excep- 
tional part-time  practice.  Colorado  and 
Nationwide.  Outstanding  fringes,  educ. 
assistance.  Air  National  Guard.  Call  Edd 
(307)772-6185.  9/0293 


♦ SITUATIONS  WANTED 

EMERGENCY  MEDICINE  work  by  M.D.- 
ER  Physician.  Experience:  25  yrs.  combined 
Er/minor/urgent  center.  Desire:  Personal 
contract  with  hospital  or  group  operating 
hosp.  ER  &/or  Minor/Urgent  center.  Salary 
& Ins.-negotiable.  Write:  Box  F.  C/O. 
Colorado  Medical  Society,  P.O.  Box  1 7550, 
Denver  CO  8021 7-0550.  4/0293 

♦ PROPERTIES  FOR  SALE  OR  LEASE 

MAUI,  HAWAII.  Luxurious  2BR/2BA, 
2,100  sq.ft,  condominium  in  Kaanapali 
Beach  Resort,  100  yards  from  beach. 
Everything's  new!  Pool,  Jacuzzi,  Sauna, 
Lighted  Tennis  Courts,  Maids.  On  16th 
fairway  of  the  Royal  Kaanapali  Golf  Club. 
Special  Fall/Winter  Rates.  Call  985-9531. 
6/0892 

Professional  Office  Space 

Excellent  location  in  Wash  Park/DU  area. 
Share  common  pt.  waiting  room  w/  2 
internists  and  1 DDS.  Three  1 0'  X 1 0'  ops, 
reception  area.  Very  reasonable.  Call  Russ, 
688-8976.  12/0792 

EAGLE/VAIL  fuliy  equipped  luxury 
townhouse  on  golf  course,  4 bedrooms,  3 
baths,  reasonable  summer-winter  rates. 
Peter  Gehret,  MD  (303)  771-0456. 

1 2/0492 

VAIL  FOR  SALE-  50%  interest  in  3500  sq. 
footvacation  home  above  the  Westin  Hotel. 
5 bedrooms,  3.5  baths,  4-car  garage, 
jacuzzi,  large  decks,  walk  to  Westin  lift. 
Call  Doug  Kirkpatrick.  Evenings  (303)  762- 
9050.  4/0193 

FOR  SALE:  Medical  Office  Building  located 
in  the  beautiful  Mtn.  community  of 
Woodland  Park,  Co.  18  Mi.  to  Colorado 
Springs  and  25  Mi.  to  Cripple  Creek.  Sale 
necessary  due  to  husband's  death.  For 
information  contact  Mrs.  R.  ).  Groeger — 
1 21 0 W.  Lorraine  Woodland  Park,  Co.  or 
call  (719)  687-2687.  6/0293 


72 


Colorado  Medicine  for  February,  1993 


Classified  Advertising 


♦ EQUIPMENT  FOR  SALE  OR  LEASE 

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used,  excellent  condition.  Model:  Con- 
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wall  bucky;  Kodak  auto  processor  M35A. 
Contact  John  Lynn  MD.  at  801  N.  Cascade 
Ave.,  C.S.  CO,  80903,  or  call  (719)  636- 
2388.  tfn/01 93 

BUY  DIRECT— LOCAL  MFGR.  Custom 
Office  Furniture — Desks,  Credenzas, 
bookcases,  Files,  work  stations,  waiting 
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♦ PRACTICES  FOR  SALE 

FAMILY  PRACTICE  FOR  SALE-  S.  Central 
Aurora,  CO-  30  patient  volume  per  day. 
Grossed  $ 230,000  last  year-Hospital 
assistance  with  setup.  Current  practitioner 
must  leave  July  1993.  Call  3-Minute 
Reader — 1-800-848-4912,  ext.  4410  or 
metro  Denver  (303)  756-6108.  2/1 292 

Aurora,  Colorado.  Large  Family  Practice 
for  sale.  Could  be  excel  lent  opportunity  for 
internist  as  well.  Substantial  gross  income 
with  potential  for  much  more.  Doctor 
retiring.  Call  Marvin  N.  Cameron,  M.D.  1 - 
303-364-4553  3/1  192 

♦ SERVICES 

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Want  to  review  literature  for  clinical  or 
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Boulder/Longmont).  12/0792 

HOME  MORTGAGE  LOANS 
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physicians  and  other  health  professionals. 
Purchase  and  refinance.  Call  Milt,  a 
mortgage  banker  with  1 8 years  experience. 
753-6262.  12/1292 


INOVATIONS  SHOULD  BE  PATENTED  if 

marketable.  For  more  information  cal  I Brian 
D.  Smith  of  Fields,  Lewis,  Pittenger  & Rost. 
Colo's  leading  patent  law  firm.  Mr.  Smith 
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(MCSS).  A sophisticated  search  program 
containing  1993  CPT  and  ICD-9  codes. 
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My  doctor  took  the  time  to 
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ill*® 


Colorado  Medicine  tor  February,  1993 


73 


Ruminations 


(def:  to  chew  again  what  has  been  chewed  slightly  and  swallowed;  to  REFLECT) 


by  Bill  Pierson,  Managing  Editor 

"A  bill  will  be  proposed  this  year  to  repeal  or  modify  Colorado  Revised  Statutes  §1 2-36-1 1 7(1  )(m)  of  the  Medical 
Practice  Act  which  prohibits  the  'corporate  practice  of  medicine.'" 

from  President's  Letter,  Colorado  Medicine  Vol.  90,  Issue  # 2 , February,  '93 

He  didn't  say  it  was  something  new; 

Front  page  - The  Denver  Post,  June  17,  1954 


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74 


From  the  front  page  of  The  Denver  Post,  Thursday,  June  17,  1954 


Hospitals 
Map  War  on 

Medic  Ban 

By  JOHN  SNYDER 
Denver  Post  Staff  Writer 

Colorado  hospitals  were  geared  Thursday 
for  a “fight  to  the  finish”  against  enforcement 
action  by  a state  board  which  they  claim  may 
close  the  state's  hospitals  “within  60  days.” 

The  state  body  is  the  board  of  medical 
examiners  headed  by  Dr.  George  Buck  of 
Denver. 

The  enforcement  action  would  prohibit  the 
state's  hospitals  from  continuing  to  hire  pa- 
thology specialists  to  run  their  laboratories 
and  radiology  specialists  to  operate  their  X- 
ray  departments.  Hospital  officials  said  it  also 
would  remove  this  work  from  present  Blue 
Cross  coverage. 

Meeting  Wednesday  afternoon  in  the 
Denison  auditorium  at  Colorado  General  Hos- 
pital, members  of  the  Colorado  Hospital  Assn, 
voted  unanimously  to  take  “whatever  legal 
action  is  necessary"  to  block  the  state  board 
from  acting  against  physicians  or  hospitals 
operating  under  the  "hiring”  arrangement. 

ALMOST  UNANIMOUS 

They  also  voted — almost  unanimously — to 
pay  for  political  expenses  if  the  court  fight 
fails  and  they  have  to  take  their  case  to  the 
legislature  for  a change  in  state  law. 

The  law  under  which  the  state  board  is 
acting  is  the  medical  practices  act,  which  says 
that  no  licensed  doctor  can  operate  as  the 
employe,  agent  of,  or  in  joint  venture  with,  a 
corporation.  Attorney  General  Duke  W. 
Dunbar  has  held  this  applies  to  hospitals, 
which  with  few  exceptions  in  Colorado  are 
non-profit  corporations. 

The  law  originally  was  passed  in  1915  and 
was  reenacted  in  1951.  Hospitals  have  been 
employing  their  radiologists  and  pathologists 
for  many  years. 

Louis  Liswood,  an  administrator  at  Na- 
tional Jewish  Hospital  and  chairman  of  the 
hospital  group's  legislative  committee,  charged 
at  the  meeting  Wednesday  that  the  state  board's 
sudden  enforcement  demand  was  “clearly  an 
attempt  by  a few  members  of  the  medical 
profession  to  practice  monopolistic  medicine 
...  on  the  sick  and  the  poor  of  the  state.” 

HIGHER  COST  SEEN 

Msgr.  John  R.  Mulroy,  head  of  the  Denver 
Catholic  Charities  and  a past  president  of  the 
hospital  association,  claimed  enforcement  of 
the  law  will  increase  hospital  payments  by 
patients  “by  30  pet.” 

If  Dunbar's  interpretation  of  the  law  is  en- 
forced, he  said,  “the  hospitals  of  the  state  may 
have  to  close  their  doors  in  60  days.  That's 


quite  inside  the  realm  of  reality.” 

“The  attorney  general  is  not  the  law  of  the 
land.  I know  enough  about  law  to  know  that. 
This  thing  is  ridiculous. 

“We’re  willing  to  take  on,  if  need  be,  the 
state  board  of  medical  examiners.” 

The  group,  made  up  of  86  hospitals,  also 
voted  to  try  to  secure  an  amendment  to  the 
medical  practices  act  which  would  legalize 
the  physician-hiring  arrangement,  make  last- 
ditch  attempts  to  peacefully  get  Dunbar  to 
change  his  mind  and  to  reach  an  amicable 
settlement  with  the  medical  board. 


Feature,  The  Denver  Post,  November  7,  1954 


The  Great 
Hospital  Scrap 

By  ROBERT  BYERS 

Denver  Post  Staff  Writer 

Look  for  a controversy  between  hospitals  and 
the  medical  profession  at  the  state  legislative 
session  in  January. 

While  the  docs  may  have  more  political 
power  than  the  hospitals,  the  latter  are  not 
without  influential  friends. 

Nub  of  the  dispute  is  the  radiologist-pa- 
thologist controversy — can  such  “doctor  spe- 
cialists,” under  the  1951  medical  practices  act, 
legally  work  on  salary  as  employes  of  hospital 
corporations?  Most  everyone  admits  they  have 
been  doing  so  for  years — so  long,  in  fact,  the 
hospitals  claim  a right  to  continue  the  practice. 
• 

The  real  issue  insofar  as  the  hospitals  are 
concerned  is  money.  It's  always  tough 
keeping  a hospital  solvent.  Two  of  the  most 
lucrative  departments  are  laboratory  and  the 
X-ray.  Moreover,  if  hospitals  have  to  lease 
their  lab  and  X-ray  equipment  to  private  - 
practicing  physicians,  there's  a chance  taxes 
will  have  to  be  paid  by  the  hospitals  on 
equipment  that  is  now  exempt. 

Beyond  that,  the  hospitals  want  to  run 
their  own  institutions,  including  laboratories 
and  X-ray  departments  as  well  as  house- 
keeping and  nursing  services. 

The  doctors'  position,  on  the  other  hand, 
is  understandable.  The  state  law  forbids 
medical  doctors  to  practice  medicine  as  the 
agents  or  employes  of,  or  in  joint  venture 
with,  unlicensed  persons,  including 
corporations.  The  attorney  general  has  ruled 
that  even  though  a hospital  corporation  is 
non-profit,  the  prohibition  affecting  doctors 
applies  just  the  same. 

The  thought  behind  the  ban  on  the 
“corporate  practice”  of  medicine  is 
certainly  laudable.  Such  a practice  is  not 
infrequently  the  device  of  the  quack  or  a 


pretender  to  medical  skills — one  who 
advertises  himself  as  something  he  isn't. 

• 

The  legislature  has  some  responsibility  to 
protect  Colorado's  public  from  such  quacks. 
The  controversial  section  17  (m)  in  the 
medical  practices  act  is  partly  for  that 
protection.  No  one,  not  even  the  hospitals, 
would  say  that  was  put  in  there  to  destroy 
hospitals. 

The  state  medical  examiners  have  ruled 
that  if  a radiologist  or  a pathologist  will 
merely  include  his  name  on  the  bill  to  the 
patient  for  X-ray  or  lab  services,  and  then 
accept  a percentage  of  the  department’s 
annual  income,  the  law  will  be  satisfied. 

The  doctor-specialist  would  still  be  in 
charge  of  the  department,  including  fees. 

The  amount  of  money  involved  would  be 
the  same  as  now.  The  doctor's  percentage 
could  be  fixed  to  equal  his  present  salary. 
Charges  to  patients  would  be  the  same,  as 
would  the  hospital’s  take. 

Hospitals  contend,  however,  this 
arrangement  is  a subterfuge;  that  doctor- 
specialists  so  employed  are  still  in  "joint 
venture  with”  hospitals,  even  though  they 
are  not  “agents  or  employes."  The  hospitals 
want  to  be  relieved  of  being  in  technical 
violation  of  the  law. 

• 

Doctors,  however,  are  ready  to  go  down  the 
line  for  the  ban  against  corporate  practice  of 
medicine.  That's  a principle  with  the 
profession,  and  they  feel  that  a change  in 
section  17  (m)  would  open  doors  to 
corporation  medical  practices  here. 

Both  sides  claim  to  be  working  “in  the 
best  public  interest."  It's  in  the  public 
interest  for  hospitals  to  pay  their  own  way 
as  much  as  possible.  It  is  in  the  best  public 
interest  also  for  the  medical  profession  to 
maintain  professional  disciplines  and 
standards  that  keep  the  quality  and  integrity 
of  medical  practices  high. 

At  loggerheads  now,  the  two  groups  will 
probably  dump  the  matter  in  the  laps  of  the 
legislators. 


Nothing  much  has  changed. 


Colorado  Medicine  for  February,  1993 


75 


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ch,  1993  Volume  90,  Number  3 


Are  the  beds  full?  As  a physician,  should  that  be  my  concern? 
Should  I minister  to  the  patient  or  the  balance  sheet? 

Now  that  I'm  an  employee,  who  will  be  the  patient's  advocate? 


This  Issue: 

egrating  the  Health  Care  System Leigh  Truitt , MD 

rporate  Practice  of  Medicine — Member  Survey  Results Page  88 

erim  Meeting  1993 Page  95 

IS  Scholarship  Aids  Unique  Medical  Student Page  WO 


When  You  Slop  For 
Malpractice  Insurance, 
Low  Bid  Doesn’t  Always  Give 
You  The  Real  Bottom  Line 

Chances  are,  if  a Colorado  physician,  or  a medical  manager,  comparison  shops 
for  malpractice  insurance,  Copic  Insurance  Company  will  offer  the  best  price, 
when  all  of  the  discounts  and  dividends  are  sorted  out  ♦♦♦  Even  so,  low  bid 
doesn’t  give  you  the  real  bottom  line.  If  responsiveness  to  policyholder  needs 
and  many -faceted  contributions  to  the  Colorado  physician  community  are 
factored  in,  Copic’s  out  - of  - state  competitors  can’t  even  come  close.  ♦♦♦  Besides, 
low  bid  could  carry  a very  high  price  if  - as  happened  a few  years  ago  - Copic’s 
competitors  drop  Colorado  like  a hot  potato  and  flee  the  state  when  the  going 
gets  rough,  or  when  the  process  server  drops  the  summons  or  subpoena. 

♦♦♦  Copic’s  here  to  stay.  And,  our  damage  control  and  legal  defense  teams  are 
the  best  in  the  business. 

The  Copic  Bottom  Line. 

It’s  more  than  just  competitive  rates. 


(ope 


Copic  Insurance  Company 

RO.  Box  17540  • Denver,  CO  80217-0540  • (303)  779-0044  • 1-800-421-1834 





Colorado  Medicine 

March,  1993  Volume  90,  Number  3 


Cover  Story 

The  physician  may  feel  a change  in  his/her 
relationship  with  the  hospitals.  Is  this  good  or 
bad!1  Is  proposed  change  in  the  Colorado 
Medical  Practice  Act  something  to  be  feared, 
or  is  it  a "paper  tiger?"  See  both  MED-FAX 
reports  and  the  latest  from  the  legislature  in 
this  issue. 


Departments 


87  President's  Letter 
90  Board  Highlights 
92  Committee  Update 

I 06  New  members 
109 Medical  News 

1 1 1 Classified  Advertising 

I I 4 Ruminations 


Hn  This 

87  Integrating  the  Health  Care  System 


Leigh  Truitt , MD 
President,  Colorado  Medical  Society 


88  Corporate  Practice  of  Medicine — Member  Survey 
Results 


89  Physicians  Explore  Quality  Improvement — at  CQI 

Seminar 

C/7  Maestas,  II 


91 


HB-1 1 35 — New  Assignment  of  Benefits  Law  Allows 
Direct  Payment 

Jo  Parkin,  Program  Manager 
Edie  Register,  Director 
Health  Care  Financing 


94  Physician's  Directory  Information  Being  Compiled — 

Make  Sure  Your  Listing  is  Accurate 


95  Special  Interim  Meeting  Section 


1 00  CMS  Scholarship  Goes  to  Unique  Individual 

Michael  P.  Thompson 
Assistant  Managing  Editor 


102  OSHA  Inspections — Here  are  some  resources  to  help 
you  get  ready 

104  9Health  Fair — Endorsed  by  the  Colorado  Medical 
Society 


105  Wade  Blank  Dies — Disables  Community  Suffers  Loss 


Colorado  Medical  Society 


COLORADO  MEDICAL  SOCIETY 
OFFICERS,  BOARD  MEMBERS  and  AMA  DELEGATES 


1992/1993  Officers 
Leigh  Truitt,  M.D. 

President 

Wm.  Carl  Bailey,  MD 

President-elect 
Terrance  J.  Sullivan,  M.D. 

Treasurer 

Stuart  O.  Silverberg,  M.D. 

Speaker  of  the  House 

David  C.  Martz,  M.D. 

Vice-speaker  of  the  House 

Sandra  L.  Maloney 

Secretary/Executive  Director 

Harrison  G.  Butler,  III,  M.D. 

(Immediate  Past  President) 


Board  of  Directors 


Board  of  Directors 


Thomas  J.  Allen,  MD 
Stephen  G.  Batuello,  MD 
John  O.  Cletcher,  Jr.,  MD 
Donald  G.  Eckhoff,  MD 
John  E.  El  I iff,  MD 
Jonathan  C.  Feeney,  MD 
David  C.  S.  Franklin,  MD 
Joel  M.  Karlin,  MD 
George  M.  Kreye,  MD 
Muryl  L.  Laman,  MD 
Ted  T.  Lewis,  MD 
Maura  J.  Lofaro,  MS  IV 
Louise  L.  McDonald,  MD 
Robert  R.  Montgomery, 

Legal  Counsel 
Robert  A.  Nathan,  MD 
Kenneth  M.  Olds,  MD 
Lothar  K.  Roller,  MD 


Dieter  W.  Schneider,  MD 
David  Shander,  MD 
W.  George  Shanks,  MD 
Susan  A.  Sherman,  MD 
Gary  D.  VanderArk,  MD 
Denis  J.  Winder,  MD 
M.  Robert  Yakely,  MD 

AMA  Delegates 

M.  Ray  Painter,  Jr.,  MD 
Richert  E.  Quinn,  Jr.,  MD 
Mark  A.  Levine,  MD 

Alternate  Delegates 

Robert  D.  McCartney,  MD 
Robert  M.  Bogin,  MD 
Joel  M.  Karlin,  MD 


COLORADO  MEDICAL  SOCIETY  STAFF 


Executive  Office 

Sandra  L.  Maloney,  Executive  Director 
Mary  Lee  Johnston,  Executive  Admin.  Asst. 
Nancy  L.  Deter,  Manager,  Accounting 

Western  Slope  Office 

Dolores  M.  Bennett,  Executive  Secretary 

Division  of  Membership  Information  Services 

Timothy  H.  Roberts,  Director 
Diane  L.  LeHew,  Manager,  Support  Services 
Debra  M.  Jones,  Membership  Coordinator 
Beth  M.  Crusha,  Administrative  Assistant 

Division  of  Professional  Services 

Sandra  M.  Finney,  Director 
Lorraine  H.  Heth,  Program  Manager 
Kirsten  E.  Regalado,  Secretary 


Division  of  Health  Care  Policy 

Ellen  J.  Stein,  Director 

Marilyn  P.  Barton,  Program  Manager 

Lynn  R.  Livingston,  Administrative  Assistant 

Division  of  Health  Care  Financing 

Edie  K.  Register,  Director 
Marijo  M.  Parkin,  Program  Manager 

Division  of  Government  Relations 

Sue  Ellen  Quam,  Director 

Lorraine  L.  Koehn,  Program  Manager/Lobbyist 

K.  Suzanne  Hamilton,  Administrative  Assistant 

Division  of  Communications 

William  S.  Pierson,  Director 

Michael  P.  Thompson,  Communications  Spec. 

Gil  Maestas  II,  Communications  Staff 


COLORADO  MEDICINE  (ISSN-01 99-7343)  is  published  monthly  as  the  official  journal  of  the  Colorado  Medical  Society,  7800  E.  Dorado  PI.,  Englewood,  CO  801 1 1 . Telephone  (303)  779-5455.  Outside 
Denver  area,  call  1 -800-654-5653.  Second  Class  postage  paid  at  Englewood,  Colorado,  and  at  additional  mailing  offices.  POSTMASTER,  send  address  changes  to  COLORADO  MEDICINE,  P.  O.  BOX 
1 7550,  Denver,  CO  8021  7-0550.  Address  all  correspondence  relating  to  subscriptions,  advertising  or  address  changes,  manuscripts,  organizational  and  other  news  items  regarding  the  editorial  content 
to  the  editorial  and  business  office.  Subscriptions  are  available  for  $30  per  year,  paid  in  advance. 

COLORADO  MEDICINE  magazine  is  the  official  journal  of  the  Colorado  Medical  Society,  but  as  such  is  also  authorized  to  carry  general  advertising.  Publication  of  any  advertisement  in  COLORADO 
MEDICINE  does  not  imply  an  endorsement  or  sponsorship  by  the  Colorado  Medical  Society  of  the  product  or  service  advertised.  Published  articles  represent  opinions  of  the  authors  and  do  not  necessarily 
reflect  the  official  policy  of  the  Colorado  Medical  Society  unless  clearly  specified. 

Sandra  L.  Maloney,  Executive  Editor;  William  S.  Pierson,  Managing  Editor;  Michael  Thompson,  Asst.  Managing  Editor 


Member,  Colorado  Press  Association, 


Member,  Colorado  Broadcasters  Association 


80 


Colorado  Medicine  for  March,  1993 


CMS  Med  Fax 

® 


AT  PRESS  TIME... 

...a  compilation  of  medically-related  news  briefs  of  immediate  interest  to  the  physician  community  occurring 
after  COLORADO  MEDICINE  has  gone  to  press. 

CMS  Med  Fax. 

by  Montgomery  Little  and  McGrew,  P.C. 

legal  counsel  to  the  Colorado  Medical  Society 


The  Health  Care  Reform  Train  is 
Out  of  the  Station 

Where  Will  This  Track  Lead? 


(February  24)  Aurora  Representative  Mike  Coffman 
introduced  legislation  this  week  which  would  make 
sweeping  changes  in  Colorado’s  Health  Care  system. 
One  provision,  especially,  would  drastically  affect  the 
way  physicians  practice  medicine. 


Hospitals  Could  Employ 
Physicians 

Coffman  titles  his  bill  CONCERNING 
HEALTH  CARE  COVERAGE  REFORM, 
and  it  is  promoted  as  affecting  the 
insurance  industry.  Many  aspects  of  it,  - 

though,  affect  medical  practice,  especially 
a provision  to  allow  hospitals  to  employ  I 

physicians.  Rep.  Coffman 

The  bill  proposes  extensive  changes 
in  the  Medical  Practice  Act.  The  noteworthy  one  here  is 
Section  22  [CRS  12-36-117  (1)  (m)].  Coffman’s  bill 
would  eliminate  the  present  wording  on  unprofessional 
conduct  and  define  it  solely  as:  “accepting  direction 
related  to  professional  judgment  in  the  practice  of 
medicine  from  any  person  who  does  not  hold  a license 
to  practice  medicine  in  the  state”. 

Presently  no  organization  (hospital,  HMO  or 
whatever)  can  employ  a physician  because  a physician 
cannot  practice  “as  the  partner,  agent  or  employee  of, 
or  in  joint  adventure  with,  any  person  who  does  not  hold 
a license  to  practice  medicine”.  Eliminating  that  provi- 
sion and  prohibiting  only  “accepting  direction”  means 
that  the  hospital  or  other  organization  can  do  whatever 
it  wants  and  the  physician  is  held  responsible  not  to 
bend  to  the  extreme  pressures  that  would  be  brought  to 
bear.  There  were  no  provisions  protecting  physicians 


from  these  pressures  or  requiring  hospitals  to  be 
responsible  for  their  actions. 

Other  Provisions 

Coffman’s  bill  would  also  prohibit  physicians  from 
referring  patients  to  facilities  in  which  they  have  a 
financial  interest,  require  the  state  Department  of  Social 
Services  to  seek  federal  Medicaid  waivers  necessary 
for  a comprehensive  health  care  plan  such  as  Colo- 
radoCare,  require  insurance  carriers  to  reveal  adminis- 
trative costs,  restrict  annual  rate  hikes,  prohibit  drop- 
ping coverage  over  pre-existing  conditions,  require  the 
company  to  write  basic  policies  to  any  group  seeking 
coverage  and  limit  what  a company  can  charge  high- 
risk  groups. 

The  bill  would  pave  the  way  for  many  aspects  of 
ColoradoCare,  the  Governor’s  plan  for  revamping 
health  care  delivery  and,  according  to  Coffman,  mesh 
with  likely  proposals  by  President  Clinton,  “I  think 
there’s  a question  what  the  Clinton  administration  will, 
in  fact,  effect  in  the  area  of  health  care,”  Coffman  told 
the  Denver  Post,  “ I believe  they’ll  give  the  states 
authority  to  work  in  cooperation  with  them.” 

Action  Needed 

Coffman’s  bill  had  not  been  assigned  a number  at 
press  time  but  with  the  blistering  pace  the  legislature  is 
expected  to  take  this  year  action  could  be  fast  and 
furious.  That  means  physicians  need  to  contact  their 
own  representatives  right  away  and  let  them  know  what 


continued  following  next  page... 


Colorado  Medicine  for  March,  1993 


83 


MONTGOMERY 

LITTLE 

& 

McGREW 

ATTORNEYS  AT  LAW 


Legal  News 

by  Karen  B.  Best,  Esq..,  an  associate  with  the  firm 
of  Montgomery  Little  & McGrew,  PC.  This  column  is  not 

legal  advice,  but  is  for  general  information  only.  For 
help  with  specific  problems,  readers  should  consult  an 

attorney. 

The  Oregon  Plan  - Revised 

In  1992,  Oregon  submitted  to  HHS  a Plan  which 
would  have  narrowed  the  scope  of  covered  services 
from  709  to  587  categories  of  treatment,  ranked  the 
categories  in  order  of  medical  effectiveness,  and  would 
have  broadened  the  availability  of  those  covered 
services.  HHS  Secretary  Sullivan  rejected  the  Plan, 
claiming  that  it  would  violate  the  Americans  With 
Disabilities  Act.  Oregon  is  back,  this  time  asking  the 
Bush  or  Clinton  administration  to  approve  a revised 
Plan  covering  688  services.  On  what  basis  does 
Oregon  determine  which  services  to  include?  According 
to  Gov.  Roberts,  they  now  “reflect  only  the  degree  to 
which  a particular  treatment  saved  life  or  returned  a 
person  to  his  or  her  original  health  status  without 
placing  a value  on  that  status.”  The  new  list  gives 
higher  priority  to  treating  low  birth  weight  babies  and 
alcoholics  as  well  as  those  dying  from  AIDS. 

Medicare/Medicaid  Program 
Fraud 

Not  only  are  the  following  scams  no  longer  paying 
off,  but  the  health  care  providers  involved  have  been 
excluded  from  participation  in  Medicaid  or  Medicare 
and  federally-funded  state  healthcare  programs. 

A physician  billed  Blue  Cross  and  Blue  Shield 
(“BOBS”)  for  brand  name  drugs  while  supplying  the  less 
expensive  generic  forms. 

The  same  physician  billed  BOBS  for  filling  prescrip- 
tions while  supplying  less  than  the  prescribed  amount 
of  the  medication. 

A testing  laboratory  bundled  unnecessary  tests  — 
cholesterol  and  iron  tests  — with  its  basic  blood  work 
tests  then  billed  Medicare  and  Medicaid  as  much  a $18 
extra  Tor  each  test. 

Over  a three  year  period  a physician  submitted 
Medicaid  claims  in  his  own  name,  for  services  claimed 
to  have  been  rendered  by  an  unlicensed  foreign 
physician. 

A podiatrist  billed  Medicaid  for  orthotics  made  from 


Mea  Pax: 
Medico- 


casts  when  she  had,  in  fact,  supplied  patients  with 
orthotics  made  from  two-dimensional  tracings. 

A general  practitioner  solicited  and  received 
kickbacks  for  referrals  to  an  ambulance  service,  and 
billed  for  services  not  rendered. 

A podiatrist  submitted  bills  to  Medicaid  for  custom- 
ized foot  molds  which  were  not  in  fact,  customized. 

A physician  billed  Medicaid  for  treatment  rendered 
to  an  undercover  agent  and  fictitious  members  of  the 
agent’s  family. 

Medical  License 
Renewal 
Deadline  Looms 

Make  Sure  Your  Address  is 
Current 

Ail  Colorado  medical  licenses  expire  May  31,  1993. 
In  order  to  receive  the  renewal  application  physicians 
must  have  a correct  “address  of  record”  on  file  with  the 
Medical  Board.  If  you  have  moved  from  the  location 
where  you  last  received  the  Board’s  newsletter  and 
have  not  yet  updated  your  address,  please  submit  the 
change  in  writing  to:  Colorado  Board  of  Medical  Exam- 
iners, Attn:  Susan  Rose,  1560  Broadway,  Suite  1300, 
Denver,  CO  80202-5140.  Renewal  application  materials 
are  time  sensitive.  Do  not  rely  on  your  mail  service  to 
forward  the  packet  in  time  to  renew  your  license. 


CMS  Locum  Tenens  Project 

CMS  has  developed  a locum  tenens  project.  CMS 
will  act  as  a matching  service  between  host  physicians 
and  locum  tenens.  Guidelines  for  establishing  locum 
tenens  coverage  will  be  provided  to  participating 
physicians.  We  currently  have  a pool  of  over  20 
physicians  interested  in  serving  as  locum  tenens. 

There  is  no  cost  to  CMS  members  for  these  services. 

If  you  have  questions  about  the  program,  please 
call  (303)779-5455  (in  the  Denver  area)  or  1-800-654- 
5653  (outside  the  metro  area).  CMS  staff  will  be  glad  to 
assist  you. 


84 


Colorado  Medicine  for  March,  1993 


CMS  Med  Fax 


Legislative  Freight  Train 


they  think  of  this,  and  other  legislation,  including  the 
following. 

Corporate  Practice 
Legislation 

(February  24)  HB93-1244  CONCERNING  THE 
EMPLOYMENT  OF  Health  Care  Professionals  by 
Licensed  Certified  Hospitals  with  Low  Population  was 
passed  by  the  House  of  Representatives  on  a vote  of 
43  to  22.  the  bill  had  come  from  the  House  HEWI 
Committee. 

Those  voting  in  opposition  in  committee  included 
Epps,  Kreutz,  Nichol  and  Pankey.  Those  voting  for  the 
bill  included  Blue,  Greenwood,  R.  Hernandez,  Law- 
rence, Morrison  and  Prinster.  Representative  Prinster 
offered  numerous  amendments  to  the  bill.  The  bill 
appears  to  have  a good  chance  to  pass  the  Senate. 
Now  is  the  time  to  call  your  Senator  and  express  your 
opposition  to  this  bill. 

Excellent  testimony  was  delivered  regarding 
physician  and  patient  concerns  from  Drs.  Leigh  Truitt 
(CMS  President),  John  Elliff,  Dennis  Chalus,  Ted 
Youngberg,  Richard  Wolfe,  and  CMS  attorney  David 
Burlage.  Please  thank  them  as  well  for  taking  time  out 
of  their  busy  practices  to  testify  on  your  behalf.  CMS 
membership  overwhelmingly  opposed  this  legislation 
when  surveyed  earlier  this  month. 

CMS  remains  opposed  to  this  legislation  as  we  do 
not  believe  that  allowing  hospitals  to  directly  employ 
physicians  in  low  population  centers  will  increase 
retention  or  enhance  recruitment  in  rural  areas.  All 
states,  including  those  which  allow  hospitals  to  directly 
employ  physicians,  continue  to  suffer  from  the  same 
physician  recruitment  and  retention  problems  in  rural 
communities. 

Talking  Points 

1 .  Even  in  states  that  specifically  permit 
hospital  employment  of  physicians,  rural  hospitals  in 


from  previous  page 

those  states  still  have  the  same  difficulties  recruiting 
physicians  as  do  hospitals  in  Colorado.  As  pointed  out 
in  the  study  entitled  State  Prohibitions  On  Hospital 
Employment  Of  Physicians  prepared  by  the  Office  of 
Inspector  General,  factors  other  than  prohibitions  and 
hospital  employment  of  physicians  are  more  important 
limitations  in  their  ability  to  assure  physician  coverage 
in  their  hospitals.  These  factors  include  a shortage  of 
specialty  physicians,  low  reimbursement  rates,  fear  of 
increased  malpractice  liability,  and  the  disruption  of 
their  private  practices. 

2.  While  it  has  been  repeatedly  stated 
that  Colorado  is  one  of  only  five  states  that  expressly 
prohibit  the  corporate  practice  of  medicine  the  majority 
of  states  have  not  enacted  legislation  either  prohibiting 
or  permitting  hospitals  to  hire  physicians.  Most  are 
silent  on  the  question. 

3.  Where  laws  have  been  passed  autho- 
rizing the  corporate  practice  of  medicine,  the  legislation 
is  commonly  drafted  to  preserve  the  physician’s  duty  to 
direct  and  control  the  provision  of  medical  care,  while 
allowing  hospitals  only  to  direct  or  control  managerial 
and  administrative  functions  within  the  facility.  House 
Bill  1244  as  introduced,  is  much  broader  than  the 
typical  legislation  authorizing  the  corporate  practice  of 
medicine.  As  originally  written,  House  Bill  1244  would 
allow  the  hospital  to  control  the  utilization  of  diagnostic 
and  treatment  modalities,  which  is  the  essence  of  the 
practice  of  medicine.  Representative  Mary  Ellen  Epps 
proposed  an  amendment  in  the  House  HEWI  commit- 
tee which  removed  the  hospitals  ability  to  control  the 
utilization  of  diagnostic  and  treatment  modalities.  This 
amendment  was  adopted  and  it  will  be  important  to 
retain  this  amendment. 

4.  Rural  hospitals  can  by  contract,  recruit 
physicians  and  provide  those  physicians  with  the  same 
benefits  which  can  be  provided  to  them  through  an 
employer-employee  relationship. 

5.  The  Health  Care  Advisory  Board,  a 
Washington,  DC.  organization,  that  represents  hun- 

continued  following  next  page... 


Colorado  Medicine  for  March,  1993 


85 


CMS  Med  Fax 


Legislative  Freight  Train 


dreds  of  hospitals  throughout  the  United  States,  issued 
a document  in  1990  called  Competitive  Strategy:  10+ 
Long  Term  Strategic  Positions  for  Hospitals!’.  This  250 
page  document  describes  strategies  for  hospitals  to 
“guarantee  future  revenue  stream  and  improve  margins 
in  times  of  intense  competition”.  The  premier  survival 
strategy,  according  to  the  Advisory  Board,  is  to  “control” 
physicians  by  employing  them.  As  employers,  hospitals 
can  insure  referrals,  limit  utilization  and  gain  de  facto 
control  over  peers. 

6.  If  a hospital  does  negligently  practice 
medicine,  what  is  the  impact  on  the  patient?  There  is 
no  language  in  this  proposed  legislation  that  indicates 
hospitals  will  be  held  liable  for  violating  standards  of 
medicai  practice. 

7.  The  effect  of  this  legislation  on  peer 
review  is  to  bypass  the  traditional  peer  review  mecha- 


from  previous  page 

nism  in  favor  of  termination  of  the  problem  physician. 

8.  Physicians  may  be  adversely  impacted 
by  hospital  decisions  regarding  the  utilization  of  ser- 
vices, facilities  and  equipment  such  that  an  adverse 
report  may  be  sent  to  the  National  Practitioner  Data 
Bank  or  to  the  State  Board  of  Medical  Examiners.  Will 
the  hospital  back  the  physician  when  he  or  she,  by 
following  hospital  policy,  is  accused  by  an  outsider  of 
the  negligent  practice  of  medicine? 

9.  The  employment  of  physicians  by 
hospitals  will  adversely  impact  the  ability  of  a non- 
employee  physician  who  is  attempting  to  compete 
financially  with  the  employed  physician  in  a small  rural 
town.  This  is  primarily  because  hospital  based  referrals 
will  be  sent  to  the  hospital  employee  as  opposed  to  the 
physician  who  simply  holds  hospital  privileges,  but  is 
not  an  employee. 


Colorado  Medical  Society  provides  the  following 
listings  of  events  as  a member  service  only.  Some 
events  are  approved  for  Continuing  Medical  Education 
credits.  Information  is  provided  by  the  sponsoring 
organizations.  For  more  details,  use  the  telephone 
contact  at  the  end  of  the  listing. 

Colorado  Hospital  Association 

Building  and  Facilitating  Teams  in  a Health  Care 

Organization 

March  25,  26th 

Denver,  CO 

Denver  Hilton  South 

(303)  758-1630 

P/SL  Healthcare  System 

UROGYNECOLOGY:  1993  State  of  the  Art 

April  2-4 

Frisco,  Colorado 

CME  Credit 

(303)  331-0692,  or  800-633-6824 


Colorado  Department  of  Health 

Advances  in  Preventive  Cardiovascular  Care:  What’s 

Hot  - What’s  Not 

CME  Credit 

April  9,  1993 

Denver,  CO 

Sheraton  Denver  Tech  Center 
(303)  327-9050 

Colorado  Speech-Language-Hearing  Association 

CSHA  1993  Annual  Convention 
April  22,23,  and  24,  1993 
Radisson  Resort 
Vail,  Colorado 
(303)  753-1221 

Presbyterian/St.  Luke’s  Medical  Center 

Born  Too  Soon:  The  Perinatal  Team,  (CME  credit) 
Saturday,  April  17,  1993 
Denver,  CO 

Call  (303)  869-1900  or  1 -800-633-6824 

American  Managed  Care  and  Review  Assoc.  (CME 
credit) 

May  6-7,  1993 
Forum  Hotel  Chicago 
Chicago,  Illinois 
(202)728-0506 


86 


Colorado  Medicine  for  March,  1993 


Photo  by  Rocky  Mountain  News 


Leigh  Truitt,  MD 
President,  1992-1993 


President's 


Integrating  the  Health  Care  System 


If  not  through  vertical  integra- 
tion, how  will  the  health  care  system 
be  coordinated?  Charles  Handy  of 
the  London  Business  School  has 
proposed  federalism  as  a means  of 
business  organization:1 

“One  of  the  world’s  oldest  political 
philosophies  is  its  newest  subject  of 
interest.  The  European  Community, 
the  new  Commonwealth  of  Indepen- 
dent States,  Canada,  Czechoslova- 
kia, and  many  more  are  all  reexamin- 
ing what  federalism  really  means. 
Businesses  and  other  organizations 
are  beginning  to  do  the  same.  Every- 
where companies  are  restructuring, 
creating  integrated  organizations,  glo- 
bal networks,  and  “leaner,  meaner” 
corporate  centers.  In  so  doing, 
whether  they  recognize  it  or  not,  they 
are  on  a path  to  federalism  as  the  way 
to  govern  their  increasingly  complex 
organizations. 

The  concept  of  federalism  is  par- 
ticularly appropriate  since  it  offers  a 
well-recognized  way  to  deal  with 
paradoxes  of  power  and  control:  the 
need  to  make  things  big  by  keeping 
them  small,  to  encourage  autonomy 
but  within  bounds,  to  combine  vari- 
ety and  shared  purpose,  individuality 
and  partnership,  local  and  global, 
tribal  region  and  nation  state,  or  na- 
tion state  and  regional  bloc.” 

For  health  care  systems  to 
understand  the  organizational 
demands  of  federalism,  they  must 
acknowledge  the  following  three 
paradoxes: 

• Organizations  must  be  both  big 
and  small  at  the  same  time. 

• Free  and  open  markets  [are]  the 
best  guarantee  of  efficiency,  even 


as  ...  managers  instinctively  or- 
ganize their  own  operations  for 
centralized  control. 

• [There]  is  a desire  to  run  a busi- 
ness as  if  it  were  yours  when  you 
cannot  afford,  or  may  not  want, 
to  make  it  yours. 

Handy  has  given  us  the  follow- 
ing five  principles  defining  federal- 
ism: 

Principle  No.  1 — Subsidiarity 
places  power  at  the  corporation's 
lowest  point. 

"Power  is  assumed  to  lie  at  the 
lowest  point  in  the  organization  and 
it  can  be  taken  away  only  by  agree- 
ment." We  are  well  aware  that 
physicians  control  70%  to  80%  of 
the  health  care  expenditures.  Many 
health  care  reform  proponents  are 
advocating  a National  Health  Board 
to  control  budgeting  and  utilization  - 
- a clear  violation  of  this  principle. 
Principle  No.  2 — Interdependence 
spreads  power  around,  avoiding  the 
risks  of  a central  bureaucracy. 

This  is  "pluralism  --  many  centers  of 
power  and  expertise."  This  fits  health 
care  as  we  know  it  well.  "Pluralism 
is  a key  element  of  federalism 
because  it  distributes  power,  avoid- 
ing the  risks  of  autocracy  and  the 
overcontrol  of  a central  bureau- 
cracy." 

Principle  No.  3 — A proper  federa- 
tion needs  a common  law,  language 
and  currency  — a uniform  way  of 
doing  business. 

In  health  care,  this  is  a management 
information  system  that  correlates 
interventions  with  outcomes  — "a 
common  information  system  so  that 
everyone  can  talk  — not  just  to  their 
answering  machines  but  also  to  their 
PCs." 


Principle  No.  4 — Separation  of 
powers  keeps  management,  moni- 
toring, and  governance  in  segre- 
gated units. 

In  health  care,  physicians  and 
administrators  manage,  but  we  also 
need  to  learn  how  to  monitor  and 
how  to  govern.  Those  are  critical 
questions  now.  As  professionals,  I 
hope  we  will  meet  these  challenges. 
Principle  No.  5 — Twin  citizenship 
ensures  a strong  federal  presence  in 
a strong  independent  region. 

For  physicians,  this  means  that  we 
are  loyal  and  supportive  not  only  of 
ourselves  and  our  group  but  also  of 
the  larger  organizations  that  contract 
for  and  coordinate  health  care. 

"What  is  good  for  me  should  also  be 
good  for  the  organization."  Too  often 
we  have  had  adversarial  relation- 
ships with  other  parts  of  the  health 
care  system  and  also  with  insurers  or 
HMOs. 

I have  attempted  to  summarize  a 
complex  argument.  Please  read  the 
original  article  for  a full  appreciation. 
We  are  looking  for  a different  way  of 
managing  health  care  — one  that 
builds  on  the  traditional  strengths  of 
independent  practice  while  permit- 
ting the  organization  necessary  to 
ensure  high  quality  and  cost  effec- 
tiveness. I do  not  believe  we  will  find 
this  in  vertical  integration  with 
common  ownership.  Perhaps  we 
should  look  to  federalism  to  bring  us 
together  in  a horizontal  network  of 
distributed  production  of  health  care. 


1 This  is  based  on  Charles  Handy,  "Balancing 
Corporate  Power;  A New  Federalist  Paper," 
Harvard  Business  Review.  November-Decem- 
ber,  1992,  pp.  61-72. 


Colorado  Medicine  for  March,  1993 


87 


Corporate  Practice  of  Medicine 

CMS  Membership  Survey  Results 


“Should  hospitals  be  allowed  to  employ  physicians?” 
Responses  by  age  category 


No 

Only  in  small  counties 

Yes— Statewide 


Total  Responses  to  the  question: 
‘Should  hospitals  be  allowed  to  employ 
physicians?” 


The  Colorado  Legisla- 
ture has  again  been 
examining  the  question 
of  whether  it  should  be 
legal  to  "employ" 
physicians.  It  has  been 
illegal  for  many  years, 
based  on  the  contention 
the  an  employer  tells  an 
° employee  what  to  do, 

| thus  creating  the 

? "corporate  practice  of 

medicine". 

Of  course,  physi- 
cians themselves  have 
long  been  the  most  vocal  in  the 
condemnation  of  "corporate  prac- 
tice" since  they  see  it  as  an  infringe- 
ment on  their  professional  autonomy 
and  ability  to  make  independent 
medical  decisions  based  on  their 
knowledge  and  expertise. 

These  waters  have  been  mud- 
died in  recent  years  by  the  upsurge 
in  health  maintenance  organizations 
and  other  managed  care  approaches 
to  medicine.  While  some  depend  on 
primary  care  "gate  keepers,"  others 
give  physicians  themselves  wide 
latitude  in  medical 
decisions. 

No  matter  how  wide 
the  latitude  however, 
they  are  limited  by  the 
fact  that  the  organization 
will  only  pay  for  certain 
services.  The  rise  of 
DRGs  and  utilization 
review  in  hospitals  has 
raised  similar  questions. 
When  a physician  has  to 
become  a patient  advo- 
cate to  convince  the 
system  what  is  "medi- 
cally necessary"  then  the 


"corporation"  gains  a much  greater 
influence  on  medical  decisions. 

Because  physician  opinion  on 
this  subject  seems  to  be  changing, 
the  leadership  of  the  Colorado 
Medical  Society  did  not  want  to  take 
a strong  stand  on  this  legislation 
without  learning  more  of  its  mem- 
bers' opinions.  So  far,  nearly  a fourth 
of  our  4,600  members  have  re- 
sponded to  a survey  mailed  out  in 
February  asking  the  question, 

"Should  hospitals  be  allowed  to 
employ  physicians'1" 

Respondents  were  given  a third 
choice  between  yes  and  no.  Since 
employment  of  physicians  has  been 
touted  as  valuable  in  underserved 
areas,  physicians  were  asked  their 
opinion  on  allowing  the  practice  in 
counties  with  a population  of  less 
than  1 00,000. 

A sizable  difference  in  opinions 
by  age  did  not  materialize.  A few 
more  older  physicians  said  no,  while 
a few  younger  ones  said  yes,  or  gave 
a qualified  yes,  but  these  differences 
were  not  significant.  Younger  and 
older  physicians  were  largely  against 
corporate  practice,  though  with  a 
sizable  minority.  (See  accompanying 
charts.) 

As  CMS  leadership  sets  policy 
and  lobbies  for  or  against  legislation 
in  this  critical  area,  it  wants  most  of 
all  to  represent  its  membership.  If 
you  have  not  returned  your  survey 
form,  please  search  the  In-box  and 
complete  it  immediately.  We  want  to 
have  the  most  broad-based  response 
possible  as  together  we  face  the 
challenges  of  practicing  medicine  in 
the  90's. 


88 


Colorado  Medicine  for  March,  1993 


Physicians  Explore  Quality 
Improvement 

Seminar  offers  introduction  to  how  CQI 
is  used  in  Colorado 


Story  and  photos  by  C/7  Maestas,  II 


On  January  1 5,  1 993  the  Colo- 
rado Medical  Society  in  conjunction 
with  Barbara  Sowada  of  St.  Mary's 
Hospital  in  Grand  Junction  con- 
ducted a Continuous  Quality  Im- 
provement (CQI)  seminar.  The 
seminar  was  held  at  the  Hyatt 
Regency  Tech  Center  Denver. 

CQI  is  a concept  that  has 
primarily  been  used  by  industry  to 
promote  and  insure  quality  and  the 
optimum  internal  communications  of 
a business  or  organization.  Over  the 
past  decade  it  has  been  used  in 
virtually  every  area  of  "Big  Business" 
including  medicine. 

The  overall  objectives  for  this 
CQI  seminar  were  as  follows:  Upon 
completion  of  this  activity,  partici- 
pants should  be  able  to  contrast  and 
compare  three  hospitals,  in  their 
implementation  of  Continuous 
Quality  Improvement  and  use  these 
experiences  to  determine  how  CQI 
could  be  used  in  their  own  organiza- 
tion: a)  why  CQI  is  the  primary  tool 
for  managing  change  and  fostering 
organizational  transformation;  b) 
what  has  worked  and  has  not 
worked  in  the  implementation  of 
CQI;  and  c)  ways  to  involve  physi- 
cians in  CQI.  The  three  hospitals  that 
took  part  in  the  seminar  were  the  St. 
Francis  Health  Care  System,  Colo- 
rado Springs,  Parkview  Episcopal 
Medical  Center,  Pueblo  and  St 
Mary's  Hospital  and  Medical  Center, 
Grand  Junction. 

The  program  began  at  8:30  am 
with  a welcome  and  introduction  by 
Leigh  Truitt,  MD,  President,  CMS. 

The  day  included  various  aspects 
and  techniques  that  play  a role  in 
initiating  a successful  CQI  program. 


Highlights  of 
the  seminar 
included;  CQI 
and  its  role  in 
shaping  the 
future,  three 
separate  sce- 
narios of  CQI 
implementation, 

Physician  train- 
ing, Physician 
involvement,  and 
CQI:  the  leader- 
ship challenge, 
presented  by 
Michael  Pugh,  President/CEO, 
Parkview. 

Here  are  a few  comments  made 
by  CQI  participants;  "Great  introduc- 
tion to  CQI  - well  organized."  "This 
was  one  of  the  most  informative 
seminars  I have  ever  attended. 
Michael  Pugh  was  Grrreat!"  "Excel- 
lent - gave  good  solutions  and  steps 
for  implementing." 

The  Colorado  Medical  Society 
hopes  to  continue 
efforts  to  provide 
productive  and 
informative  semi- 
nars that  are  of 
value  to  our 
members  and  all 
health  care  profes- 
sionals. 


CMS  President  Leigh  Truitt,  MD 
opened  the  session  with  a general 
overview  of  the  concept  of  Contin- 
uous Quality  Improvement.  Present- 
ers throughout  the  day  explained 
how  they  had  implemented  CQI  in 
their  hospitals,  how  physicians  and 
other  health  care  professionals  had 
benefited  and  some  of  the  major 
lessons  they  had  learned  about 
implementing  CQI  in  a health  care 
setting. 


1992 


LEARNED 


;e  waste, r s c|jnical 
jmplexity,  excess  c 
ity,  wrong  clinica 

ns  and  malpractice. 


Colorado  Medicine  tor  March,  1993 


89 


Highlights:  Board  of  Directors  Meeting 
January  22,  1993 


CMSA:  Mrs.  Pam  Laman,  President,  reported  that  Mrs.  Mary  Hanson  will  be  installed  as 
President  of  the  AMA  Auxiliary  during  the  Annual  Meeting  in  Chicago  in  June. 

Medical  Executive  Group:  Ms.  Dolores  Bennett,  as  Chair  of  the  group,  requested  that  CMS  do  a mailing  to 

membership  on  the  issue  of  "corporate  medical  practice",  to  include  an  explanation 
of  the  term  and  a survey  to  determine  the  physicians'  opinion  on  the  subject. 

AMA  Delegation:  Dr.  Mark  Levine  reviewed  the  actions  of  the  AMA  House  of  Delegates  during  the 

Interim  Meeting  in  December.  A motion  was  passed  to  ask  the  Council  on  Ethical  & 
Judicial  Affairs  to  review  the  issues  of  self-referral  as  defined  by  the  AMA  and  make 
recommendations  to  the  Board  of  Directors  and  subsequently  to  the  House  of 
Delegates. 


Executive  Committee:  The  Board  ratified  the  actions  of  the  Executive  Committee  in  deciding  to  initiate 

discussions  with  managed  care  organizations  for  the  purpose  of  developing  a pilot 
managed  care  type  of  program  for  Medicaid. 

Finance  Committee:  The  Board  ratified  the  actions  of  the  Finance  Committee  in  approving  a proposal  for 

CMS  to  sponsor  a golf  tournament  for  the  purpose  of  raising  funds  to  be  used  for 
medical  indigent  needs  as  recommended  by  the  Committee  on  Medical  indigency. 


Board  of  Directors:  The  Board  approved  the  recommendation  from  the  Organizational  Study  Committee 

to  increase  the  President  honorarium  to  $50,000  and  the  President-elect  honorarium 
to  $25,000. 

The  Board  also  approved  a motion  which  would  make  the  President  of  the  AMA 
Auxiliary  an  ex-officio  member  of  the  Board  of  Directors  when  that  person  is  from 
Colorado. 


The  Board  also  approved  the  following  legislative  activities;  1)  oppose  the  lay 
midwifery  legislation,  2)  support  legislation  to  expand  HIV  anonymous  test  sites,  3) 
oppose  the  legislation  to  remove  smoking  restrictions  from  certain  public  places  and 
4),  to  develop  legislation  to  introduce  concepts  of  managed  care. 


90 


Colorado  Medicine  for  March,  1993 


HB  1135 


New  assignment  of  benefits  law  allows  direct  payment 

by  jo  Parkin,  Program  Manager 
Edie  Register,  Director 

Health  Care  Financing 


A new  assignment  of  benefits 
iaw  went  into  effect  in  Colorado  on 
January  1 , 1 993  which  applies  to 
non-profit  health  service  corpora- 
tions. According  to  the  Division  of 
Insurance,  there  are  four  such 
entities  in  Colorado:  Blue  Cross  and 
Blue  Shield  of  Colorado,  Delta 
Dental,  HSI  Health  Plans,  Inc.,  and 
Colorado  Vision  Services.  This  law 
enables  subscribers  of  these  health 
plans  to  assign  their  medical  benefits 
to  providers  of  service  and  have 
providers  paid  directly.  Until  now, 
these  organizations  have  not  been 
required  to  pay  providers  directly  if 
they  did  not  have  a contract  with 
them. 

Since  this  law  will  primarily 
affect  physicians  in  their  dealings 
with  Blue  Cross  and  Blue  Shield  of 
Colorado  (BCBSC),  we  contacted 
BCBSC  and  obtained  the  following 
information. 

• The  law  does  not  apply  to  self- 
funded  groups,  national  accounts 
and  the  Federal  Employees  Health 
Benefits  Plan.  This  means  that 
BCBSC  is  not  required  to  honor  an 
assignment  of  benefits  from  subscrib- 

Sample  assignment  of  benefits  (below) 


ers  of  these  groups.  These  subscrib- 
ers are  identified  by  their  identifica- 
tion cards. 

• If  your  patients  want  to  assign 
benefits,  you  simply  need  to  have 
them  sign  box  1 3 on  your  HCFA- 
1 500  claim  form  before  submitting 
your  bill. 


If  you  use  a superbill,  you  must 
submit  an  assignment  of  benefits 
with  your  claim.  A sample  assign- 
ment of  benefits  form  is  shown 
below. 

Keep  these  things  in  mind  when 
submitting  an  assigned  claim: 

1.  BCBSC  will  not  accept  assign- 
ments after  the  fact,  nor  will  they 
keep  them  on  file  as  they  do  with 
Medicare.  This  means  that  you  must 
submit  an  assignment  of  benefits 
each  time  you  submit  a claim  for  a 
patient. 


2.  Unlike  Medicare,  patients  do  not 
remove  their  obligation  for  addi- 
tional charges  when  they  assign 
benefits  to  a provider.  Physicians 
not  under  contract  with  BCBSC  may 
balance  bill  patients  for  charges  not 
covered  by  their  insurance. 

3.  You  cannot  submit  an 
assigned  claim 
to  BCBSC 
electronically 
because  the 
assignment 
cannot  be 
submitted  in  this 
fashion. 

The  law  states  that  once  you  bill 
BCBSC  you  must  also  provide  a copy 
of  the  bill  to  your  patient  stating  that 
it  is  for  informational  purposes  only 
and  that  their  insurer  has  been  billed 
for  covered  benefits.  If  payment  is 
sent  to  the  patient  instead  of  you, 
and  the  patient  does  not  pay  in  a 
timely  manner,  BCBSC  is  responsible 
for  paying  within  30  days  of  being 
notified  of  the  lack  of  payment. 


Box  13  of  HCFA-15G0 


13.  INSURED'S  OR  AUTHORIZED  PERSON'S  SIGNATURE  I authorize 
payment  of  medica!  benefits  to  the  undersigned  physician  or  supplier  for 
services  described  below. 


SIGNED 


ASSIGNMENT  OF  BENEFITS 


Patient's  Name 


Patient's  Insurance  Identification  Number, 

Subscriber's  Name 

Provider's  Name 


Date  of  Service 


I authorize  medical  benefits  for  services  rendered  on  the  date  and  by  the  provider  identified  above  to  be  paid 
to  the  provider 


Insured's  or  authorized  person's  signature 


Colorado  Medicine  for  March,  1993 


91 


A monthly  report  of 
current  and  on-going 
activities  of  the  Councils , 
Committees  and  Sections 
of  the  Colorado  Medical 
Society.  None  of  the 
information  herein  is 
meant  to  indicate  a policy 
or  position  statement  of 
the  Colorado  Medical 
Society.  This  report  is 
designed  only  to  inform 
CMS  members  of  their 
orga  n iza  tion  s a cti  vi ties 
and  study  projects  at  the 
Council Committee  or 
Section  level. 


The  Committee  on  Accreditation, 

chaired  by  Dr.  L.  H.  Stahlgren,  met 
February  4 and  took  the  following 
actions:  approved  re-accreditation 
for  Accord  Medical  Center  and 
Arkansas  Valley  Regional  Medical 
Center  and  approved  initial  accredi- 
tation for  Columbine  Psychiatric 
Center;  accepted  progress  reports 
submitted  by  two  organizations;  and 
approved  distribution  of  the  latest 
issue  of  "Facts  and  Tips."  "Facts  and 
Tips"  was  presented  at  the  national 
Alliance  for  Continuing  Medical 
Education  meeting  as  an  example  of 
innovative  ways  accrediting  bodies 
support  their  sponsors  of  CME. 

The  Coalition  on  Senior  Issues, 
chaired  by  Muryl  Laman,  MD,  will 
meet  March  1 5 at  2:00  p.m.  at  the 
CMS  offices.  The  Coalition  is  very 
interested  in  health  care  reform  and 
will  begin  reviewing  a number  of 
health  care  reform  plans. 

The  Council  on  Professional 
Education,  chaired  by  Richard 
Bakemeier,  MD,  met  February  18. 
Action  items  will  be  reported  in  the 
next  issue  of  Colorado  Medicine. 

The  next  meeting  is  scheduled  on 
May  20  at  2:00  p.m.  at  the  CMS 
offices. 

President  W.  Gerald  Rainer,  MD, 
will  chair  the  CMS  Education  and 
Research  Foundation  Board  meeting 
at  his  offices  on  April  1 7 at  4:30  p.m. 


Summary  of  Minutes 

Colorado  Rural 
Health  Resource 
Center 

January  Membership  Meeting 

Executive  Director's  Report 

Denise  Denton  updated  every- 
one on  some  of  the  activities  the 
Center  has  been  involved  in  for  the 
last  three  months. 

CATI  Grant:  The  Center 
received  a technical  assistance  grant 
from  the  Colorado  Advanced 
Technology  Institute  to  assess 
telecommunications  resources 
projects  available  to  rural  Colorado. 
The  Center  will  work  with  the  Rocky 
Mountain  Farmers  Union,  The 
Colorado  FTospital  Association,  the 
UCF1SC  School  of  Nursing  and  the 
Colorado  Medical  Society  on  this 
project.  Anyone  interested  in 
participating  is  welcome. 

April  16  Meeting:  with  the 
Colorado  Perinatal  Care  Council  on 
April!  6.  The  two  groups  will 
discuss  Colorado's  rural  perinatal 
issues  and  develop  recommenda- 
tions for  addressing  them. 

1 -800  #:  The  Center  hopes 
to  have  a toll-free  number  set  up  by 
April  so  that  rural  people  being 
served  by  the  Center  do  not  have  to 
pay  for  the  phone  call. 

Colorado  Department  of  Health 
Update 

Patricia  Nolan , MD,  MPH 

Reform  Initiative  Committee. 

She  feels  there  will  be  some  restruc- 
turing of  programs  at  the  state  level, 
including  mental  health  and  youth 


92 


Colorado  Medicine  for  March,  1993 


programs,  Drug  and  Alcohol  Abuse 
and  the  formation  of  a Health  Care 
Policy  and  Enhancement  Committee. 
Reform  will  be  at  both  the  state  and 
local  level  due  in  part  to  Amendment 
One  and  its  effects  on  health  care. 

Dr.  Nolan  reported  on  a bill  being 
drafted  to  deal  with  ColoradoCare 
and  state  health  care  reform  and 
restructuring  of  programs.  Missing 
from  the  bill  is  local  level  involve- 
ment and  restructuring  of  social 
services.  Dr.  Nolan  felt  that  the 
Center  should  be  thinking  about:  1 ) 
local  and  state  spending  levels,  2) 
how  to  run  clinical  programs,  3) 
education  - personal  health  care,  and 
4)  public  health  sector  - health  status 
and  health  services. 

Statewide  Health  Care  Needs 
Assessment 

Maureen  Hong 

Maureen  Hong,  Executive 
Director  of  Colorado  Community 
Health  Network,  gave  an  update  on 
the  statewide  health  care  needs 
assessment  done  by  the  federally 


funded  Primary  Care  Cooperative 
Agreement.  This  assessment  and  the 
prioritization  of  needs  have  been 
required  of  all  states  by  the  Bureau  of 
Primary  Health  Care.  This  informa- 
tion will  be  used  to  make  funding 
and  resource  allocation  decisions.  A 
statewide  prioritization  of  the  needs 
and  strategies  to  address  them  is  clue 
May  1 5th.  A February  9th  meeting 
from  9 - noon  is  scheduled  to  carry 
out  this  task.  Anyone  interested  in 
participating  should  call  )anet 
Rasmussen,  with  CCHN,  at  572- 
8502. 

Rural  Health  Priorities  Input 
Session 

Reesa  Webb 

Reesa  Webb  facilitated  a discus- 
sion of  the  key  health  issues  which 
the  Center  should  be  addressing  in 
the  coming  year.  The  group  listed 
issues  which  will  be  combined  with 
those  mailed  in  by  members.  These 
issues  will  be  developed  into  a 
survey  for  prioritization  and  com- 
ment by  the  entire  membership. 


For  information  on  the 
meeting  times  of  a council 
or  committee  in  which 
you  are  interested , call 
(303)  779-5455  or  1-800- 
654-5653  and  speak  to 
the  appropriate  CMS  staff 
person. 


RUN  A SPECIAL 
PRACTICE. 

Today’s  Air  Force  has  special  opportuni- 
ties for  qualified  physicians  and  physi- 
cian specialists.  To  pursue  medical  excel- 
lence without  the  overhead  of  a private 
practice,  talk  to  an  Air  Force  medical  pro- 
gram manager  about  the  quality  lifestyle, 
quality  benefits  and  30  days  of  vacation 
with  pay  each  year  that  are  part  of  a 
medical  career  with  the  Air  Force.  Dis- 
cover how  special  an  Air  Force  practice 
can  be.  Call 


TOLL-FREE 

USAF  HEALTH  PROFESSIONS 
1-800-423-USAF 


Colorado  Medicine  for  March,  1993 


93 


1993  Physician's  Directory  Cards 
in  the  Mail 

The  accuracy  of  your  listing  depends  on  YOU 


Is  your  name  spelled  correctly? 


Mary  L Jones,  DO 
Office  Address: 

1 0643  Ridgeway  Rd 
Alamosa 
0081101(719)845-0951 


Do  we  have  your  home  and  office  addresses  and  phone  numbers  correct?  Please 
note  if  you  would  prefer  an  address  or  phone  number  be  unlisted. 


Home  Address: 

93  Fairway  Dr 
Del  Norte 
0081132(719)846-0211 


.YES  NO 


HAVEYOURETIREDFROMPRACTICE: 

Specialties:  FAMILY  PRACTICE 

THORACIC  SURGERY 

We  can  list  up  to  five  special 


NEW  THIS  YEAR,  we  can  list  your  foreign 
languages.  Please  fill  in  up  to  four 


Foreign  Languages : 


Please  sign: 


Spanish 

Farsi 

Gaelic 

Indonesian 


ties.  Colleagues'  ability  to  refer 
to  you  is  determined  by  how 
accurately  you  provide  us  with 
this  information. 


Dear  Doctor: 

What  you  see  on  the  attached  card  will  be  your  listing  in 
the 

1993  CMS  PHYSICIAN  S DIRECTORY 
Medical  Office  Resource  Book. 

Please  note  that  a foreign  language  listing  has  been  added. 
This  is  very  important!  Indicate  what  languages  are  spoken  in 
your  offices.  We  can  store  up  to  four  languages. 

Make  changes  or  corrections  on  the  attached  card  and 

sign  it. 

Return  it,  with  or  without  changes,  by  April  3,  1993. 

Thank  you. 


If  you  have  already  re- 
tired, this  item  will  ask 
you  if  you  are  STILL  re- 
tired. Please  make  sure 
we  know  your  status. 


Your  signature  (not  your 
office  staff)  assures  the 
accuracy  of  your  listing 


Thisisthe  printed card 
you  will  find  in  your 
mailbox.  On  the  re- 
verse will  be  a label 
with  the  information 
above.  Please  fill  itout 
immediately  and  re- 
turn it  to  CMS.  If  you 
do  not  return  it  soon 
enough,  or  if  you  do 
not  make  certain  the 
information  is  accu- 
rate, we  will  not  be 
able  to  accurately 
update  your  record  in 
our  files.  Thank  you 
for  your  cooperation. 


94 


Colorado  Medicine  for  March,  1993 


It's  a Critical  Time  for  Organized 

Medicine 


That's  why  we,  and  the  CMS  staff,  have  worked  hard  to  bring  you  a high  quality  Interim  Meeting,  dealing  with  some 
of  the  critical  issues  you  will  be  facing  as  you  practice  medicine  in  the  months  and  years  to  come. 

Please  take  a took  at  the  following  pages,  register  for  the  meeting  and  plan  to  join  us  for  this  important  time  of 

charting  the  course  of  organized  medicine  in  the  era  of  health  care  reform. 

Leigh  Truitt,  MD  Sandra  L.  Maloney 

President  Executive  Director 


"Humanization  of  Medicine" 
at  Interim  Meeting 

Dr.  Marianne  Neifert,  a Denver  Pediatric  specialist,  will  speak  to  the  Women  in  Medicine  Section  of  the  Colorado 
Medical  Society  about  the  effect  women  physicians  have  had  on  the  practice  of  medicine  in  general,  April  2,  1993, 
during  the  Interim  Meeting. 

Dr.  Neifert  is  a co-founder  and  Medical  Director  of  the  Lactation  program  at  Presbyterian/St.  Luke's  Medical 
Center,  and  Medical  Director  of  the  Mother's  Milk  Bank  in  Denver.  She  is  also  Associate  Clinical  Professor  of  Pediat- 
rics at  the  University  of  Colorado  School  of  Medicine  and  a member  of  the  Professional  Advisory  Board  of  La  Leche 
League  International.  She  is  a widely  recognized  author,  researcher,  columnist  and  lecturer,  on  a national  level,  as 
well  as  here  in  Colorado. 

Dr.  Neifert  says  that  women  have  had  a profound  effect  on  medicine  that  is  only  just  beginning.  For  example, 
when  women  physicians  took  time  off  for  their  families,  male  physicians  were  freed  to  spend  more  time  with  families 
as  well.  She  calls  the  feminization  of  medicine  the  "humanization"  of  medicine,  because  it  has  allowed  all  physicians 
to  be  more  human  and  less  driven. 

The  Women  in  Medicine  Section  has  also  sponsored  a Resolution  calling  for  and  end  to  discrimination  based  on 
"sexual  orientation,  age,  gender,  religion,  national  origin,  skin  color  and  disability,  with  the  understanding  that  these 
are  unrelated,  per  se,  to  the  delivery  of  quality  patient  care,  professional  ability  or  judgment."  This  resolution  will  be 
debated  at  the  Interim  Meeting. 

Dr.  Louise  McDonald,  Chair  of  the  Women  in  Medicine  Section  says  this  organized  expression  of  the  feminine 
viewpoint  "must  continue  until  CMS  has  discovered  and  addressed  ...the  needs  of  women  physicians  in  this  state." 
She  said  the  Section  needs  to  work  toward  having  more  women  involved  in  CMS  leadership  and  recruiting  more  of 
Colorado's  women  physicians  as  members. 


Colorado  Medicine  for  March,  1993 


95 


Colorado  Medical  Society 
Interim  Meeting — April  3-4,  1993 


Friday,  April  2, 

, 1993 

1 :30  pm 

— 4:00  pm 

Reference  Committee 

1 1 :30  am 

- 1 :00  pm 

Finance  Committee 

1 :30  pm 

— 4:00  pm 

Reference  Committee 

1 :00  pm  - 

-4:00  pm 

Board  of  Directors 

3:30  pm 

— 6:00  pm 

Reference  Committee 

3:00  pm  - 

- 5 :00  pm 

Health  Care  Reform — 

3:30  pm 

— 6:00  pm 

Reference  Committee 

Medicaid 

3:00  pm  - 

-5:00  pm 

Health  Care  Reform  — 

Sunday,  April  4,  1993 

Worker's  Compensation 

7:00  am 

- 1 1 :Q0  am 

Registration 

5:00  pm  - 

- 7 :00  pm 

Registration 

7:00  am 

— 8:30  am 

Arapahoe  Medical  Society 

5:30  pm  - 

-7:00  pm 

Welcome  reception 

caucus 

sponsored  by  El  Paso  County 

7:00  am 

— 8:30  am 

AuroraAdams  County 

Medical  Society 

Medical  Society  caucus 

6:30  pm  - 

-9:30  pm 

Women  in  Medicine  Section 

7:00  am 

— 8:30  am 

Boulder  County  Medical 

Dinner  and  Business  Meeting 

Society  caucus 

7:00  am 

— 8:30  am 

Denver  Medical  Society 

Saturday,  April  3,  1993 

caucus 

7:00  am  - 

-5:00  pm 

Registration 

7:00  am 

— 8:30  am 

El  Paso  County  Medical 

7 :00  am  - 

-9:00  am 

Reference  Committee 

Society  caucus 

Breakfast 

7:00  am 

— 8:30  am 

Larimer  /Weld  County 

7 :00  am  - 

-8:30  am 

Nominating  Committee  Open 

Medical  Societies  caucus 

Forum 

7:00  am 

— 8:30  am 

Pueblo/Western  Slope 

8:30  am  - 

-9:00  am 

Credentials  Committee 

Medical  Societies  caucus 

9:00  am  - 

-9:30  am 

FHouse  of  Delegates  Opening 

8:00  am 

— 8:30  am 

Credentials  Committee 

Session 

8:30  am 

— 12:00  N 

Flouse  of  Delegates 

9:30  am~ 

1 1 :45  am 

General  Membership  Meeting 

Concluding  Session 

12:00  N - 

- 1 :30  pm 

Luncheon 

96 


Colorado  Medicine  for  March,  1993 


INTERIM  MEETING  REGISTRATION 

1993  Interim  Meeting  of  the  Colorado  Medical  Society,  April  3-4,  1993,  Sheraton  Colorado  Springs  Hotel 


Name  (please  type  or  print) 

Name  of  Spouse/Guest  (if  attending)  

Component  Society Office  Phone  

Please  check  all  that  apply 

O Women  in  Medicine  O Young  Physicians  O Resident  Physicians  O Hospital  Medical  Staff 

Section  Section  Section  Section 

O Component  Society  □ Program  Speaker  O Press  O Other  

Executive 

If  you  are  not  a member  of  CMS,  please  provide  the  following: 

Company/Organization  

Title 

Be  sure  to  complete  both  sides  of  the  form. 


Hotel  Reservation  form  below 
Send  directly  to  hotel,  not  to  CMS 

Sheraton  Colorado  Springs  Hotel 
2886  South  Circle  Drive 
Colorado  Springs,  CO  80906-4199 
(719)576-5900  FAX  (71 9)  576-7695 

Advance  Reservation  Request 

Reservations  are  accepted  on  a guaranteed  basis  only 
(Please  complete  and  remit  early.) 


Guaranteed  Reservations 

• Send  a deposit  of  one  night's  room  charge  plus  tax  (8.6%) 

• Include  your  credit  card  number  (AMEX/DC/MCAAsa/CB) 

If  you  do  not  cancel  with  hotel  48  hours  prior  to  arrival, 
you  will  be  billed  by  the  credit  card  company  for  one 
night's  lodging,  plus  tax. 

Cancellations 

Please  don't  be  a "NO  SHOW."  If  you  cannot  stay  with  us, 
cancel  your  reservation  by  calling  the  hotel  directly  at  least  48 
hours  prior  to  arrival  and  obtain  a Cancellation  Number. 


Check-Out 

Check-out  time  is  1 1 :00  a.m. 

Check-In 

Check-in  is  not  guaranteed  prior  to  3:00  p.m. 

Special  Note 

Reservation  deadline  is  March  1,  1993.  The  preferred  rate  will  be 
extended  to  CMS  members  on  a space  available  basis  after  March  1. 

For  additional  information  or 

group  reservations  - call  719-576-5900. 


Colorado  Medicine  for  March,  1993 


97 


I 


Reservations  for  Events  and  Meetings 

(Reservation  deadline  is  March  19,  1993.  Reservations  accepted  on  a first-come,  first-served  basis.) 


Number  of 
Reservations 

Friday,  April  2,  1993 

3:00-5:00  pm  Health  Care  Reform — Medicaid  

3:00-5:00  pm  Health  Care  Reform — Worker's 

Compensation  

5:30-7:00  pm  Welcome  Reception  sponsored  by 

El  Paso  County  Medical  Society  


Amount 

Enclosed 

Complimentary 

Complimentary 

Complimentary 


Saturday,  April  3,  1993 

1 2 Noon-1 :30  pm  Luncheon  Complimentary 


Hotel  Reservations 

Please  use  the  hotel  reservation  form  in  this  issue  of  Colorado  Medicine  to  make  your  reservations  directly  with  the 
Sheraton  Colorado  Springs  Hotel.  The  deadline  for  room  reservations  is  March  1,  1993.  The  preferred  rate  will  be 
extended  to  CMS  members  on  a space  available  basis  after  March  I . 

Meeting  Registration 

Please  submit  a registration  form  by  March  19,  1993,  if  you  plan  to  attend  this  Interim  Meeting.  We're  delighted  to 
receive  it  by  mail,  fax,  or  phone.  We  can  check  you  in  more  quickly  and  efficiently  if  you've  pre-registered,  in 
addition  to  providing  more  accurate  and  therefore  cost-saving  guarantees  for  our  food  functions.  Thanks! 


Messages 

For  your  convenience,  a message  board  will  be  provided  at  the  CMS  registration  desk.  The  hotel's  phone  number  is 
71 9-576-5900.  (You  may  want  to  leave  this  number  with  someone).  If  you  need  to  be  contacted,  ask  the  hotel 
operator  to  transfer  the  call  to  the  CMS  registration  desk  or  CMS  office. 


What  To  Do 

Complete  and  return  to  Colorado  Medical  Society,  PO  Box  17550,  Denver,  CO  80217  (303-779-5455  or 

1-800-654-5653),  or  FAX  to  303-771 -8657. 


1 


Hotel  Reservation  Information 


Name  of  Group:  Colorado  Medical  Society 

Last  Name First Middle 

Company  Name Co.  Phone 

Address 


City State Zip 

Home  Address Phone 


City State Zip. 

Share  with:  Last  Name First 


Last  Name 


First 


Group  Code 


□ No  Smoking 
Room 


Rate  Check  Type 

Requested 


Single 

$58.00 

Double 

$68.00 

Triple 

$78.00 

Quad 

$88.00 

Guest  rooms  are  held  by  the  hotel  for  your  croup 

AS  LISTED  BELOW.  Any  VARIATION  IS  SUBIECT 
TO  AVAILABILITY. 

Meeting  Dates  April  2-4,  1993 

Please  make  my  reservation  for  the  following  dates: 

ARRIVAL 

DEPARTURE 

(We  must  have  this  information  in  order  to  make  your  reservation.) 

Guaranteed  Reservation 

□ Deposit  included 

□ AM/Ex  □ DC  □ MC  □ VISA  QCB 

Credit  card  No.  

Expiration  date  

Signature 


98 


Colorado  Medicine  for 


March,  1 993 


Access  to  Food 
Constitutes 
a Human  Right 

World  hunger  is  an 
ever-present  scourge  that  claims 
35,000  lives  each  day. 


Access  to  food  constitutes  a human  right.  In  1 9 76,  the  United 
States  Congress  passed  a Right  to  Food  Resolution  which 
declared  the  sense  of  the  congress  to  be  "that  all  people 
have  a right  to  a nutritionally  adequate  diet". 

Physicians  Against  World  Hunger  (PAWH),  a non-profit, 
tax-exempt  organization  was  founded  so  that  physicians 
could  collectively  defend  this  human  right  by  raising  funds  to 
support  well-recognized,  reputable  organizations  that  are 
directly  engaged  in  working  with  the  poor  primarily  for  the 
purpose  of  ending  death  by  starvation. 

Please  join  us  — together  physicians  must  help  bring  an  end 
to  world  hunger. 


# 


Physicians  Against  World  Hunger 

#2  Stowe  Road,  Peekskill,  NY  1 0566 


□ YES  I wish  to  join  PAWH  in  the  struggle  to  end  world  hunger  — enclosed  is  my  contribution. 

□ $50  a $100  □ $250  □ $500  □ Other 


NAME  PLEASE  PRINT 

ADDRESS 

CITY 

STATE 

ZIP 

SIGNATURE 

Please  forward  your  tax  deductible  contribution  to  Physicians  Against  World  Hunger  #2  Stowe  Road,  Peekskill,  NY  1 0566 


CMS  Scholarship  Leads  to 
Unique  Doctor 


by  Michael  P.  Thompson,  Assistant  Managing  Editor 


Photos  by  Gil  Maestas,  II 


If  Horatio  Alger  had  written  the  story, 
you'd  scoff  at  its  improbability.  The 
thing  that  makes  it  even  more 
interesting  is  that  it's  true,  and  it 
happened  to  one  of  your  medical 
colleagues  here  in  Colorado. 

Andrew  P.  Higgins  was  born  in 
Denver,  Colorado  twenty  six  years 
ago  and  was  adopted  by  the  parents 
of  seven  natural  children.  He  and  his 
younger  sister  were  moved  with  the 
rest  of  the  family  to  Casper,  Wyo- 
ming when  he  was  five.  If  he  experi- 
enced any  discrimination  as  one  of 
very  few  black  children  in  the  area 
(who  had  white  parents  and  siblings), 
he  didn't  let  it  slow  him  down.  Andy 
speaks  in  glowing  terms  of  the  love 
and  acceptance  of  his  parents  and 
their  example  to  him  and  his  broth- 
ers and  sisters  to  reach  out  and  make 
the  world  a better  place. 

In  fact,  he  says  that  the  experi- 
ence has  made  him  a better  person, 
"For  me  to  grow  up  in  that  environ- 
ment was  challenging  in  many  ways. 

I had  to  put  up  with  many  different 
things  that  many  people  didn't 
understand....!  think  that's  helped 
me  gain  a certain  sense  of  indepen- 
dence and  strength  to  be  able  to  put 
up  with  things  and 
to  go  beyond  that 
and  explore  other 
areas  and  other 
ideas  and  to  see 
things  for  what  they 
are." 

After  graduating 
from  high  school  in 
Casper,  Andy  lived 
with  his  aunt  and 
uncle  while  doing 
baccalaureate  work 
at  Creighton 


University  in  Omaha,  Nebraska.  The 
family  ties  helped  ease  the  culture 
shock  of  going  to  the  big  city,  but  his 
next  trip,  to  London,  England,  was 
the  beginning  of  a more  global 
vision. 

After  studying  in  London,  "the 
big  city",  Andrew  was  able  to  go  to 
Australia  and  did  six  weeks  rotations 
at  a hospital  in  Jamaica,  which  gave 
him  a taste  for  one  of  his  present 
loves,  Emergency  Medicine.  The 
experience  taught  him  that  the 
United  States  is  way  ahead  of  the  rest 
of  the  world  in  specialized  medicine, 
but  other  countries  are  good  at 
providing  general  care.  He  is  looking 
at  a research  project  comparing  the 
use  of  thrombolytic  therapy  for  heart 
attacks  in  Sweden,  Switzerland  and 
the  United  States,  to  get  an  idea  of 
how  they  compare  in  delivering 
emergency  care. 

He  is  looking  at  emergency 
medicine  because,  "you  never  know 
what's  going  to  walk  in  that  door," 
and  general  surgery  because,  "I  love 
working  with  my  hands".  He  also 
thinks  about  primary  care  because 
he  wants  to  work  with  the  whole 
person  and  the  whole  family.  "The 


100 


Colorado  Medicine  for  March,  1993 


nice  thing  about  medicine  is  that  you 
have  such  a potential  to  help  some- 
one." he  says,  echoing  the  admoni- 
tion of  his  family  to  be  of  aid  to 
people  wherever  possible. 

Much  of  what  Andrew  has  been 
able  to  accomplish  was  made 
possible  by  a scholarship  from  the 
Colorado  Medical  Society  Education 
Research  Foundation  (CMS-ERF).  Dr. 
Eugene  Jacobson,  then  dean  of  the 
School  of  Medicine,  helped  arrange 
for  the  scholarship  to  go  to  Andrew 
H iggins,  for  which  he  is  quite 
grateful,  "This  scholarship  has  given 
me  all  the  opportunities  that  I've  had 
over  the  last  four  years;  it's  given  me 
the  opportunity  to  go  to  Jamaica,  it's 
given  me  the  opportunity  to  think  of 
going  and  doing  research  in  different 
areas.  It's  the  reason  I'm  in  Colorado 
and  it's  the  reason  I'm  going  to 
medical  school  here.  It's  been  the 
thing  that's  opened  the  doors." 

Mr.  Higgins  credits  the  scholar- 
ship with  enabling  him  to  be  a 
unique  physician,  rather  than  a run 
of  the  mill  one.  Without  it,  he  would 
have  been  forced  to  go  to  a lesser 
known  school  and  participate  in  a 
Wyoming  program  requiring  him  to 
practice  there  (probably  in  a rural 
area)  for  three  years.  It  drastically 
affected  the  course  of  his  medical 
education,  future  practice  and  his 
life.  "To  me,  it  was  offering  me  more 
opportunity,"  he  says,  "It  was 
offering  me  more  selections  without 
having  too  many  pressures  this  way 
or  that  way." 

He  is  also  very  positive  about  the 
University  of  Colorado  School  of 
Medicine,  "It's  funny,  because  when 
you're  applying  to  medical  schools, 
you  hear  about  this  school,  that 


school,  different  reputations  here  and 
there.  And  I've  heard  Colorado  had  a 
good  reputation.  Then  once  I got  into 
it,  and  now  more  so  that  I'm  getting 
to  the  end  of  my  medical  school 
education,  I really  see  it.  It's  like, 
we're  potent.  This  medical  school 
has  come  up  with  a lot  of  innovative 
things." 

Andy  will  go  through  graduation 
ceremonies  with  his  class  this  May, 
but  will  not  actually  graduate  until 
December,  because  of  a unique 
internship  program  he  hopes  to 
undertake.  He  has  applied  for  a 
position  with  the  Indian  Health 
Services  to  work  in  a clinic  in  Taos, 
New  Mexico.  Along  with  one 
primary  care  physician,  he  would  be 
operating  a broad-based  health  clinic 
on  the  reservation  there.  He  sees  this 
as  a valuable  experience  to  prepare 
him  for  the  variety  of  opportunities  in 
life. 

Andy  says  that  the  cultural 
intricacies  he  faced  in  Jamaica 
should  help  him  here,  though  this 
will  be  even  another  way  of  thinking. 
Indian  peoples  are  still  suspicious  of 
Western  medicine  and  of  govern- 
ment programs,  he  says,  meaning  he 
will  have  to  overcome  many  barriers 
in  his  practice  there. 

He  gives  his  parents  much  of  the 
credit  for  his  philanthropic  bent, 
"When  I was  over  this  last  holiday 
and  told  my  mom  and  dad  about  all 
my  new  plans,  Mom  said,  'We 
would  have  loved  you  just  as  much 
when  you  wanted  to  become  a 
garbage  man.'  They're  just  those 
people  who  are  completely  sup- 
portive....My  dad  was  just  tickled 
pink  when  he  heard  I was  applying 
for  the  Indian  Health  Services.  Fie 


was  just  so  happy  about  that.  Doing 
good  for  other  is  what  they're  all 
about  and  it  just  rubs  off  on  you 
when  you  grow  up  with  it." 

Andy  Higgins  is  a modest  man, 
who  doesn't  always  think  about  his 
accomplishments,  until  they  are 
pointed  out,  "I  have  had  a unique 
life,  I must  say.  When  you  go 
through  it,  you  don't  think  much 
about  it,  but  when  you  have  time  to 
sit  down  and  reflect  about  things, 
and  particularly  transition  times  are 
great  for  that,  you  sit  back,  you  think 
about  things.  It's  like,  how  have  I 
gotten  to  where  I am  right  now  and 
where  is  this  thing  going  to  take  me 
now?  Options  just  seem  to  be 
everywhere  and  I hope  they  continue 
like  that  forever." 

Ed.  Note:  Mr.  Higgins  sent  us  a 
note  after  the  interview,  thanking  us 
for  the  opportunity,  and,  in  his 
unique  style,  wanting  to  make  sure 
we  thanked  Nancy  Nelson,  MD, 
Dean  of  Students  at  CU  Medical 
School,  Wyoming  Governor  Mike 
Sullivan,  and  the  Wyoming  WICHE 
program,  and  "a  big  thanks  to  the 
CMS  for  providing  me  the  opportu- 
nity to  study  medicine  in  this  state. " 


Colorado  Medicine  for  March,  1993 


101 


OSHA  Inspections 

Here  are  some  consultants  to  help  you  be  ready 


"to  assist  in  the 
preparation  for  OSHA 
inspections. " 


Resolution-52-P  which  was 
adopted  as  policy  at  the  CMS  1 992 
Annual  Meeting  directed  the  Medical 
Society  to  "...make  available  a list  of 
persons  who  are  qualified  to  conduct 
mock  inspections  of  physicians' 
offices  to  assist  in  the  preparation  for 
OSHA  inspections."  The  following 
list  resulted: 

Bonita  Carson,  M.D.  - 781-5301 
Dr.  Carson  acts  a consultant  for 
CMS  on  the  OSHA  Bloodborne 
Pathogen  Standard.  She  provided 
input  on  the  CMS  OSHA  packet 
which  contains  a model  exposure 
control  plan,  models  for  all  of  the 
necessary  associated  forms  and  a 
copy  of  the  standard.  Additionally, 
she  has  been  available  to  answer 
questions  or  to  provide  consultation 
on  implementation  of  the  OSHA 
regulations.  Dr.  Carson  does  facility/ 
office  inspections  which  includes  a 
written  report  and  telephone  avail- 
ability for  follow-up  questions. 
Dames  and  Moore  - 294-9100 
Contact:  Marci  Z.  Balge,  RN, 

MS,  COHN 

Dames  and  Moore  has  estab- 
lished and  managed  full  scope 
Occupational  Health  programs 
within  major  corporations,  clinics 
and  hospital  environments.  Consult- 
ing services  are  targeted  specifically 
to  clients'  needs  and  include  compli- 
ance audits  relative  to  the  OSHA 
Bloodborne  Pathogen  Standard, 
medical  waste  management  and 
worker's  compensation. 

ENSR  - 493-8878  in  Fort  Collins 
Contact:  Joe  Sanders,  Regional 
Health  and  Safety  Manager 

ENSR  Consulting  and  Engineer- 
ing is  a full  service  environmental 
consulting  company  with  offices 


nationwide.  ENSR's  staff  of  certified 
industrial  hygienists  have  over  20 
years  of  health  and  safety  experi- 
ence. 

Industrial  hygiene/health  and 
safety  services  offered  to  the  medical 
community  include  training  and 
auditing  concerning  the  OSHA 
Bloodborne  Pathogen  Standard,  as 
well  as  air  and  surface  monitoring  for 
pathogens  and  microbes.  Board 
certified  industrial  hygienists  can 
also  perform  indoor  air  monitoring 
for  anesthetics,  ethylene  oxide  and 
other  chemical  agents. 

Steve  Herron  & Associates  - 
690-0342 

Contact:  Steve  Herron,  CIH,  CSP 

Steve  Herron  & Associates 
provides  mock  inspections  of 
physician's  offices  for  compliance 
with  OSHA's  Bloodborne  Pathogen 
Standard.  A written  report  is  pro- 
vided with  all  inspections  without 
charge.  Telephone  consultation  is 
available  for  follow-up  questions. 

Industrial  Hygiene  Resources, 
Ltd.  - 431-1144 

Contact:  Lynn  M.  Gress,  Indus- 
trial Hygienist 

IHR  is  a comprehensive  indus- 
trial hygiene  consulting  company 
offering  a full  range  of  services 
including  air  monitoring,  training 
and  inspections/audits.  Relative  to 
the  OSHA  Bloodborne  Pathogen 
Standard  IHR  provides  inspections  of 
physicians'  offices  along  with  a 
written  report  of  findings  and 
recommendations. 

Hospital  Shared  Services  - 722- 
5566 

Contact:  Gail  Curry-Kane,  RN, 

BS,  MS 

Hospital  Shared  services  offers 


102 


Colorado  Medicine  for  March,  1993 


three  distinct  and  specialized 
services  to  assure  compliance  with 
the  OSHA  Bloodborne  Pathogen 
Standard. 

1 . On-site  evaluation  of  the 
procedures  and  practices  of  office 
staff.  This  includes  a step  by  step 
review  of  all  preparatory  documents 
for  your  bloodborne  pathogen  policy 
manual.  Testing  and  class  outlines 
are  included  as  well  as  all  necessary 
educational  materials. 

2.  A bloodborne  pathogen  policy 
template  that  meets  the  OSHA 
requirements  is  available  on  com- 
puter diskette.  Physicians  or  their 
office  staff  can  customize  the 
template  for  hands-on  practice  in 
their  offices.  Cost:  $95.00 

3.  HSS  can  customize  the  policy 
template  for  you. 

Cost:  $150.00 

OSHA  Colorado  On-site  Consul- 
tation Program  - 491-6151  in  Fort 
Collins 

Colorado  State  University 

Contact:  Dei  Sandfort,  Program 
Manager 

This  program  contracts  with  the 
Federal  Government  to  provide 
mock  OSHA  inspections  for  small 
businesses.  Employers  may  request 
exactly  the  type  of  inspection  they 
want;  for  instance,  they  may  request 
an  inspection  in  order  to  be  in 
compliance  with  the  blood-  borne 
pathogen  standard.  Inspections  are 
free  and  available  on  a first  come, 
first  served  basis.  Presently  there  is  a 
waiting  list  of  at  least  six  months. 
Small  business  (under  10  employees) 
are  given  priority  and  move  up  the 
list  more  quickly  than  others. 
Following  the  inspection  a written 
abatement  plan  is  sent  to  the  em- 
ployer. Consultants  have  no  contact 


with  OSHA  and  no  fines  are  issued. 
OSHA  would  be  contacted  only  in 
the  event  that  imminent  or  serious 
hazards  were  found  and  subse- 
quently not  acted  upon  by  the 
employer. 

Radian  Corporation  - 292-0800 
Contact:  Dennis  J.  Murphy,  CIH, 
CSP,  Senior  Industrial  Hygienist 

Radian  Corporation  has  provided 
technical  environmental,  health  and 
safety  services  for  over  twenty  years. 
Radian  maintains  a staff  of  Certified 
Industrial  Hygienists,  Certified  Safety 


Professionals,  Industrial  Hygienists, 
and  other  professionals  who  have 
provided  health  and  safety  services 
to  industry,  trade  groups,  and 
governmental  clients  concerning 
OSHA  compliance.  In  the  area  of 
bloodborne  pathogens,  Radian  has 
conducted  numerous  on-site  compli- 
ance surveys  to  evaluate  facilities 
with  OSHA  requirements.  Addition- 
ally, Radian  has  reviewed  written 
programs  which  clients  have  had  in 
place  as  well  as  developed  programs 
for  implementation. 


. Mm  Bit  Tiar  . 
\ Professional  / 
imputation  To 
Protect 


So  depend  on  the  expertise 
of  The  St.  Pool  and  our  knowledge 
of  your  profession. 


Seled  The  St.  Paul  for  stable,  high  limits  coverage  that 
travels  with  you.  Comprehensive  coverage  backed  by  a company 
with  $1 3 billion  in  assets  and  40  years  of  experience  in  Colorado. 
You  can  depend  on  us. 

We're  Building  Our  Reputation  By 
Protecting  Yours 

Call  your  independent  insurance  agent  and  ask  about  The  St.  Paul 
Or  call  Lisa  Good  in  our  Denver  Office  at  (303)  696-7500. 


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affiliates,  Soinl  Paul,  Minnesota  55l  02 


Colorado  Medicine  tor  March,  1993 


103 


fy  HEALTH  FAIR  — 1993 

500,000  individuals  can't  be  wrong 


MISSION:  The  Mission  of  the 
9Health  Services,  Inc.  is  to  promote 
health  awareness  and  to  encourage 
individuals  to  assume  responsibility 
for  their  own  health. 

In  keeping  with  this  mission, 
9Health  Fair  was  created  some  1 3 
years  ago  . In  the  ensuing  years 
9FHealth  Fair  has  screened  over 

500.000  individuals. 

9Health  Fair,  endorsed  by  the 
Colorado  Medical  Society,  will  be 
held  this  month  at  123  individual 
Colorado  sites  from  March  27 
through  April  4th.  Drs.  Eugene 
Weston  and  Robert  Sawyer  of  the 
Colorado  Medical  Society  are 
members  of  the  9FHealth  Services 
Board  of  Directors  and  Medical 
Health  Advisory  Committee.  Both 
Sawyer  and  Weston  emphasize 
health  education  and  personal  health 
responsibility  through  the  9Health 
Fair  at  all  of  its  sites. 

In  1992,  9Health  Fair  screened 

40.000  individuals.  5,400  persons 
chose  to  have  a colorectal  screening. 
Of  these,  93  persons  were  referred 
for  further  study,  and  there  were  5 
confirmed  malignancies.  Over 

10.000  chose  to  have  a PSA  screen- 
ing, and  of  these,  880  showed 
elevated  PSA  readings  while  82  were 
confirmed  malignant.  In  addition,  the 
1992  screening  offered  blood 
pressure  and  cholesterol  testing 
9Health  Fair  continues  to  cooperate 
with  both  the  Colorado  Urological 
Society  (for  the  prostate-testicular- 
cervical  screening)  and  the  Colorado 
Dermatological  Association  (Ameri- 
can Academy  of  Dermatology)  in 
screening  for  skin  cancer. 


During  1992,  Provenant  Health 
Partners  became  a major  sponsor  of 
the  9Health  Fair.  In  so  doing, 
Provenant  and  9Health  Fair  provided 
seventeen  corporate  health  fairs  and 
four  community  fairs,  with  5,000 
individuals  screened.  Five  of  these 
work-place  corporate  fairs  screened 
1,775  individuals,  of  whom  76% 
were  screened  for  the  first  time. 
Referred  for  further  study  were  1 78 
with  possible  skin  cancers,  333  cases 
of  hypertension  and  25  with  pros- 
tate-testicular-cervical indicators. 

I 77  showed  early  warning  signs  of 
cancers. 

That  same  year,  Provenant 
contributed  $50,000  toward  devel- 
oping a 9Health  Fair  computerized 
database  which  includes  182  fields 
with  up  to  20  components  each, 
such  as  general  demographics, 
health  history,  life  style,  screening 
results  and  individual  data.  That 
database  is  now  up  and  running,  and 
promises  to  provide  research  oppor- 
tunities to  physicians  and  other 
health  care  professionals  not  before 
available.  In  1992  alone,  over 

40,000  individual  data  sets  went  into 
this  database.  The  data  can,  in  the 
future,  be  accessed  by  such  agencies 
as  the  Centers  for  Disease  Control, 
National  Institutes  of  Health,  re- 
sources for  national  health  inter- 
views, national  demographics  and 
life  style  studies,  medical  and 
surgical  companies,  pharmaceutical 
companies,  and  many  others. 

Recent  years  have  seen  a new 
thrust  by  the  9Health  Fair  to  establish 
contact  with  students,  grades  5 
through  1 2,  through  student  health 
fairs.  These  fairs  emphasize  safety, 
alcohol  and  drug  or  substance  abuse, 


AIDS  and  nutrition.  Student  Health 
Fairs  were  held  last  year  at  thirty 
Colorado  schools,  and  over  10,000 
students  were  contacted.  The 
students  conduct  their  own  fairs  with 
assistance  by  volunteer  health 
organizations,  including  Colorado 
Medical  Society.  The  student  data  is 
being  saved  in  a health  information 
database,  again  created  and  main- 
tained by  Provenant  Health  Part- 
ners.. 

This  is  all  volunteer  effort  and, 
as  a result,  physicians  are  needed 
every  year  to  help  in  areas  of  screen- 
ing for  the  prostate-testicular-rectal 
examination,  for  dermatological  and 
peripheral  vascular  screening  as  well 
as  summary  and  referral.  The  last  is 
perhaps  the  most  important. 

If  you  can  give  any  time  or  effort, 
please  contact  9Hea!th  Fair  offices  at 
698-4455  or  your  County  Medical 
Society  executive  (who  has  all  of  the 
site  dates  and  locations).  If  nothing 
else,  contact  Colorado  Medical 
Society,  Communications  Depart- 
ment, at  (303)  779-5455  or  1-800- 
654-5653. 

9Health  Fair  is  sponsored  by 
Provenant  Health  Partners,  Tri  State 
Banks,  Life  Choice,  Colorado 
National  Guard,  Lions  Clubs  of 
Colorado,  and  KUSA-TV,  Channel  9. 
It  is  endorsed  by  the  Colorado 
Medical  Society. 


104 


Colorado  Medicine  for  March,  1993 


Disabled  rights  activist  Wade  Blank  dies  in 


On  February  15,  1993,  all  the 
world  lost  one  of  its  foremost 
champions  of  disabled  Americans. 
He  was  one  of  the  1 975  origina- 
tors of  the  Atlantis  Community  for 
disabled  people,  which  now 
includes  about  100  residents. 

In  1978,  Blank  and  other 
activists  demonstrated  to  obtain 
handicap  accessibility  to  Regional 
Transportation  District  buses,  and 
they  won  that  battle  in  short  order. 
In  the  same  year,  Blank  and  his 
associates  formed  a new  organiza- 
tion — ADAPT  — American 
Disabled  for  Accessible  Public 
Transportation. 

In  1990  Blank  demonstrated 
to  spur  passage  of  the  Americans 
with  Disabilities  Act  (ADA) 
legislation. 

Recently,  ADAPT  has  changed 
its  name  and  its  focus. ..American 
Disabled  for  Attendant  Programs 
Today,  and  a goal  of  making 
home  health  care  a right  so  that 
disabled  persons  can  live  in  their 
own  homes. 

It  was  a month  to  the  day 
before  Wade  Blank's  death  that  he 


led  a demonstration  of  ADAPT  to  the 
Colorado  Medical  Society  offices, 
asking  physicians  for  ADAPT  input 
into  the  Society's  policy  groups  (see 
Colorado  Medicine , Vol.  90,  Num- 
ber 2,  February,  7 993,  pp  66-67.). 
Blank  told  CMS  President-elect 
William  Carl  Bailey,  MD  that  his 
group  was  asking  that  the  AMA  I ) 
direct  its  members  to  reduce  nursing 
home  referrals  by  50%  in  the  first 
year;  2)  require  all  member  physi- 
cians to  make  full  disclosure  of  their 
financial  interests  in  nursing  homes 
and  institutions;  3)  mandate  that 
AMA  members  divest  themselves  of 
all  financial  interests  in  nursing 
homes  and  institutions;  and,  4)  invite 
ADAPT  to  present  at  the  next 
national  AMA  conference  and  vote 
on  ADAPT's  resolution. 

Dr.  Bailey  assured  the  demon- 
strators (approximately  35)  that  CMS 
would  follow  up  on  opening  lines  of 
communications  between  ADAPT 
and  the  physicians  and  that  their 
concerns  were  taken  seriously.  On 
hearing  of  Blank's  death,  Dr.  Bailey 
reaffirmed  the  committment,  saying 
he  would  work  to  keep  these 


vacation  accident 


communication  channels  open, 
now  that  "there  is  an  understand- 
ing" on  both  sides  on  what  the 
issues  are. 

Blank  was  a pastor  of  the 
Presbyterian  Church  and  moved  to 
Denver  from  Akron,  Ohio,  in  the 
early  1970s.  He  was  a native  of 
Pittsburgh. 

Wade  Blank,  age  52,  and  his  8 
year  old  son,  Lincoln,  died  on 
February  1 5th  during  a vacation 
trip  to  Mexico.  Wade  was  attempt- 
ing to  save  his  son,  caught  in  an 
ocean  undercurrent  while  swim- 
ming. He  is  survived  by  his  wife 
and  two  daughters.  Contributions 
for  the  family  may  be  made  to  the 
Wade  Blank  Memorial  Fund  at  the 
First  National  Bank  of  Denver,  300 
South  Federal  Boulevard,  Denver, 
CO  80206. 

A national  memorial  service 
will  be  held  for  Blank  on  May  9 at 
the  Lincoln  Memorial  in  Washing- 
ton. A trust  fund  has  been  estab- 
lished in  the  name  of  Wade  Blank. 
Contributions  can  be  sent  to 
Atlantis/ADAPT,  c/o  Evan  Kemp, 
2500  Q St.,  N.W.,  #121,  Washing- 
ton, D.C.,  20007 


Colorado  Medicine  for  March,  1993 


105 


New  members 


AURORA-ADAMS  COUNTY 
MEDICAL  SOCIETY 

Rochelle  A Sanders,  MD 
1 550  S Potomac  St  #330 
Aurora,  CO  80012 
Elected  12/1 1/92 


CLEAR  CREEK  VALLEY  MEDICAL 
SOCIETY 

Dennis  j Boyle,  MD 
8550  W 38th  Ave  #104 
Wheat  Ridge,  CO  80033 
Elected  01/06/93 

Michael  A Volz,  MD 
5800  E Evans  Ave  #1 00 
Denver,  CO  80222 
Elected  01/06/93 


CURECANTI  MEDICAL  SOCIETY 


Robert  L Boltuch,  MD 
3200  Cnty  Rd  24 
Ridgway,  CO  81432 
Elected  09/1 8/92 


DENVER  MEDICAL  SOCIETY 

Sheila  A Flynn,  MD 
1 650  Fillmore  St 
Denver,  CO  80206 
Elected  01/01/93 

Stephen  M Kutz,  MD 
1 200  Galapago  St  #5 1 0 
Denver,  CO  80204 
Elected  01/01/93 

Mark  A McGehee,  MD 
1 820  Gilpin  St  #21 0 
Denver,  CO  80218 
Elected  01/01/93 


Madelyn  S Palmer,  MD 
1 650  Fillmore  St 
Denver,  CO  80206 
Elected  01/08/93 

Linda  M Schulzkump,  MD 
1 650  Fillmore  St 
Denver,  CO  80206 
Elected  01/01/93 

Franklin  Shih,  MD 
1 2061  Tejon  St 
Denver,  CO  80234 
Elected  0 

Jeffrey  A Snyder,  MD 
4500  E 9th  Ave  #530 
Denver,  CO  80220 
Elected  01/01/93 

Margret  F Thompson,  MD 
1 650  Fillmore  St 
Denver,  CO  80206 
Elected  01/08/93 

Sherry  A Whisenant,  MD 
1 650  Fillmore  St 
Denver,  CO  80206 
Elected  01/01/93 


EL  PASO  COUNTY  MEDICAL 
SOCIETY 

Joseph  J lllig,  MD 
5325  Aubrey  Way 
Colorado  Springs,  CO  80919 
Elected  11/24/92 

William  K Kimble,  MD 
1400  E Boulder  St 
Emer  Dept 

Colorado  Springs,  CO  80909 
Elected  01/21/93 

Denise  Malek,  MD 
Penrose  Anesthesia 
2131  N Tejon  St  #L-2 
Colorado  Springs,  CO  80907 
Elected  0 


LARIMER  COUNTY  MEDICAL 
SOCIETY 

Thomas  Boylan,  DO 
1 024  Lemay  Ave 
Fort  Collins,  CO  80524 
Elected  09/02/92 

Marylida  Carline,  MD 
1 903  Churchill  Ct 
Fort  Collins,  CO  80526 
Elected  09/02/92 


Steven  D Coupens,  MD 
2500  E Prospect  Rd 
Fort  Collins,  CO  80525 
Elected  09/02/92 

Thomas  R Downes,  MD 
1 1 00  E Elizabeth  St 
Fort  Collins,  CO  80524 
Elected  1 1/1 8/92 

Michael  I Lynch,  DO 
1 100  Poudre  River  Dr 
Fort  Collins,  CO  80524 
Elected  1 2/02/92 

Dale  R Martin,  MD 
91 4 W 6th  St 
Loveland,  CO  80537 
Elected  11/18/92 

Mark  A McFerran,  MD 
2500  E Prospect  Rd 
Fort  Collins,  CO  80525 
Elected  11/18/92 

Barbara  S Mendrey,  MD 
1113  Oakridge  Dr 
Fort  Collins,  CO  80525 
Elected  1 2/02/92 

Joseph  W Schmitt,  MD 
1 762  Hoffman  Dr 
Loveland,  CO  80538 
Elected  09/02/92 


106 


Colorado  Medicine  for  March,  1993 


Michael  M Towbin,  MD 
1 025  Pennock  PI 
Fort  Collins,  CO  80524 
Elected  09/02/92 


MEDICAL  STUDENT  COMPONENT 
MEDICAL  SOCIETY 

Timothy  R Kruse 
1 030  Monroe  St 
Denver,  CO  80206 
Elected  01/04/93 

Blanca  E Richmond-Coca 
3770  W 95th  Ave 
Westminster,  CO  80030 
Elected  01/04/93 


MT.  SOPRIS  COUNTY  MEDICAL 
SOCIETY 

Joseph  C Martinez,  MD 
0401  Castle  Creek  Rd 
Aspen,  CO  81  61 1 
Elected  01/12/93 

Edward  R Watson,  MD 
121  W Bleeker  St 
Aspen,  CO  81  61 1 
Elected  10/01/88 


PUEBLO  COUNTY  MEDICAL 
SOCIETY 

Lee  A Bricker,  MD 
2002  Lake  Ave 
Pueblo,  CO  81004 
Elected  02/01/93 

Richard  Dvorak,  MD 
1 1 1 W Evans 
Pueblo,  CO  81004 
Elected  12/21/92 


Ann  C Smith,  MD 
2924  Country  Club  Dr 
Pueblo,  CO  81008 
Elected  02/01/93 


SAN  LUIS  VALLEY  MEDICAL 
SOCIETY 

Katherine  H Ruiter,  MD 
3080  Sherman  Ave 
Monte  Vista,  CO  81 144 
Elected  1 1/09/92 


If  you  have  a physician 
friend  who  is  not  a 
member  of  the  Colorado 
Medical  Society  call  (303) 
779-5455  or  1-800-654- 
5653  to  find  how  to  get 
new  member  information. 


WELD  COUNTY  MEDICAL 
SOCIETY 

I Paul  Jones  III,  MD 
1900  16th  St 
Greeley,  CO  80631 
Elected  1 2/02/92 


Physician  Recognition  Awards 

The  Colorado  Medical  Society  joins  the  American  Medical  Associa- 
tion in  recognizing  the  following  physicians  for  their  dedication  to 
excellence  in  medical  care  as  demonstrated  by  their  commitment  to 


continuing  medical  education. 

Thomas  J Collins 
Cathryn  A Culver 
Zenaida  T.  David 
Craig  J Edgerton 
Raymond  J.  Enzenauer 
Stephan  L.  Forstot 
Christian  E.  Hageseth 
Graham  W.  Hoffman 
Andre  J.  Huffmire 
Ralph  T.  Kendall 
Jude  J Kirk 
John  D.  Kirk 


David  A.  Labosky 
David  C Leistikow 
Thomas  A.  Merrick 
John  E.  Morrison 
Anthony  L Ortegon-Azuero 
Nathan  S Persoft" 

David  S Pfoff 
Scott  L.  Replogle 
Jay  A Richter 
Scott  G Smith 
Marc  H Tanenbaum 
Hugh  S Wiley 


Colorado  Medicine  for  March,  1993 


107 


Health  Care  Reform  - 
"Managed  Competition" 

by  Frederick  A.  Lewis , Jr.,  M.D. 


" On  February  17 , 

7 993 , Dr.  John  McGrath 
addressed  the  CMGMA 
on  health  care  reform. 

Dr.  McGrath  is  a mem- 
ber of  the  Clinton  health 
care  policy  team  and  also 
a participant  in  the  "Jack- 
son  Flole  Group". 

The  following  is  my 
summary  of  his  outline  of 
the  most  likely  health  care 
reform  proposals  to  be 
submitted  to  Congress  by 
President  Clinton.  Any 
errors  are  mine , not  Dr. 
McGrath's." 

Frederick  A.  Lewis,  Jr.,  M.D. 


1 .  The  establishment  of  a "National 
Health  Care  Policy  Board".  This 
will  allow  Congress  to  defer 
difficult  political  decisions  to  this 
Board  and  allow  Congress  to  get 
out  of  the  business  of  micro- 
management  of  the  health  care 
delivery  system.  One  of  the  goals 
of  this  Board  would  be  to  change 
the  primary  care/specialist  ratio 
over  the  next  several  years. 


2.  The  system  would  provide  total 
access  to  everyone  in  the  country. 
All  employers  would  be  man- 
dated to  purchase  coverage  for 
employees.  The  Medicaid  and 
uninsured  population,  medically 
indigent,  etc.,  would  join  pur- 
chasing groups  which  would  then 
negotiate  for  health  care  for  their 
members.  Interestingly,  it  was  Dr. 
McGrath's  perception  that,  at  the 
outset,  Medicare  would  not  be 
included.  This  would  be  a tactical 
and  political  decision,  essentially 
to  avoid  opposition  by  AARP. 

3.  The  creation  of  a "basic"  benefit 
package  which  would  provide 
"adequate"  health  care  benefits  to 
everyone.  Dr.  McGrath  felt  that  it 
was  vital  that  providers  have 
input  into  the  construction  of  this 
package. 

4.  Health  care  premiums  would  be 
deductible  by  corporations  and 
individuals  up  to  the  limit  of  the 
premium  required  to  pay  for  the 
"basic  benefit  package".  If 
corporations  offered  benefits  to 
employees  over  and  above  this 
level,  or  if  employees  purchased 
further  benefits  on  their  own, 
these  added  benefits  would  not 
be  tax  deductible  by  either  the 
corporation  or  the  individual 
employee.  However,  with  this 
caveat,  corporations  could 
provide,  and  individuals  pur- 
chase, any  level  of  benefits  which 
they  could  afford. 

5.  New  "entities"  would  be  devel- 
oped called  "collaborative  health 
care  networks".  As  envisioned, 
each  of  these  would  be  a partner- 
ship between  an  insuring  organi- 
zation, a hospital  or  hospitals, 
and  a network  of  providers.  Each 
insurance  company,  hospital,  or 
provider  would  be  allowed  to 
participate  in  only  one  network. 
The  networks  would  then  com- 


pete with  each  other,  presumably 
on  the  basis  of  cost  and  quality. 

6.  Some  kind  of  global  budget  or 
expenditure  target  will  probably 
be  implemented  at  a state  or 
regional  level. 

7.  The  collaborative  health  care 
networks  would  provide  health 
care  to  their  participating  mem- 
bers on  a capitated  basis.  Presum- 
ably, they  would  subcontract,  in 
some  fashion,  with  the  hospitals 
and  providers  in  their  network. 

8.  Premiums  will  be  collected  by  the 
insurance  portion  of  the  collabora- 
tive health  care  network.  It  is  not 
anticipated  that  the  Federal 
Government  will  collect  and 
disperse  premiums  as  envisioned 
under  ColoradoCare. 

9.  ERISA  regulations  and  the  various 
state  mandates  would  be  repealed. 
There  will  be  no  coverage  limita- 
tions in  terms  of  pre-existing 
illness,  premiums  will  be  commu- 
nity rated,  and  policies  will  be 
"portable"  in  the  sense  that  they 
will  move  with  the  individual  as 
he/she  changes  employment. 

10.  This  program  will  obviously  tend 
to  favor  large  groups  of  physicians 
who  already  have  a large  estab- 
lished patient  base.  Networks  will 
compete  for  these  provider  groups 
and  thus  they  should  have  a 
negotiating  advantage.  Physicians 
in  solo  private  practice  or  small 
groups  will  be  at  a competitive 
disadvantage.  Physician  reim- 
bursement would  probably  be 
based  on  RBRVS. 

11.  Questions  will  be  raised  as  to 
whether  or  not  medical  education 
should  continue  to  be  financed  by 
Medicare. 

NOTE:  Frederick  A.  Lewis,  Jr.,  M.D.,  is  a past 

president  of  CMS,  and  is  currently  a member 

of  the  Board  of  Directors  of  Copic  Insurance 

Company 


108 


Colorado  Medicine  for  March,  1993 


Medical 


Washington 

Appointment 

Denise  Denton  who  is  the  Director 

of  the  Colorado  Rural  Health  Re- 
source Center  has  been  asked  to  go 
to  Washington  for  three  months  to 
work  with  the  transition  team  on 
health  care  reform.  She  is  the 
current  president  of  the  National 
Rural  Health  Assoc  and  has  been 
involved  in  rural  health  care  for 
many  years.  At  least  we  know  that 
there  are  some  real  people  involved 
and  that  they  will  be  looking  at  rural 
health  issues. 

Patients  Wanted  for 
Asthma  Study 

The  Clinical  Research  Depart- 
ment at  Presbyterian/St.  Luke's 
Medical  Center  is  looking  for  people 
who  suffer  from  night  time  asthma. 
The  Department  is  conducting  a 
study  testing  medication  which  may 
relieve  symptoms  of  nocturnal 
asthma. 

Study  participants  must  meet  the 
following  criteria: 

* between  the  ages  of  1 8 and  65; 

* a non-smoker  for  the  last  five 
years; 

* currently  using  at  least  one 
inhaler  to  treat  asthma. 

All  medications  and  tests  associated 
with  the  study  are  free,  including 
physical  exams.  Those  who  partici- 
pate will  receive  a $200  stipend 
upon  completion  of  the  study. 

To  learn  more  about  how  you 
can  participate,  call  the  Clinical 
Research  Department  at  Presbyte- 
rian/St. Luke's,  at  (303)  839-6432. 


Patients  Needed  for 
Smoking  Cessation 
Study 

THE  P/SL  Center  for  Health 
Sciences  Education  is  looking  for 
longtime  smokers  with  emphysema 
and/or  chronic  bronchitis  who  would 
like  to  try  to  kick  the  habit.  The 
Center  is  testing  a medication  that 
could  aid  in  smoking  cessation. 

Participants  in  the  study  must 
meet  the  following  criteria: 


* at  least  1 8 years  old; 

* diagnosed  with  mild  to  moder- 
ate emphysema  or  chronic  bronchi- 
tis; 

* produce  sputum  (mucus)  ; 

* have  smoked  for  at  least  1 0 
years. 

Participation  in  the  study  is  free, 
but  only  a limited  number  of  spaces 
are  available.  Participants  will  not  be 
charged  for  test  medication  or 
treatment.  For  more  information,  call 
the  Clinical  Research  Department  at 
Presbyterian/St.  Luke's,  at  839-6432. 


Colorado  Personalized  Education  for  Physicians 

"The  positive  continuing  education  alternative  for  physicians 
For  more  information,  write  or  call: 

CPEP 

5575  DTC  Parkway,  Suite  350-A 
Englewood,  CO  80111 
(303)  773-0440 

The  key  focus  of  CPEP  is  to  offer  a positive  educational  experi- 
ence based  on  the  individual’s  learning  style  and  clinical 
knowledge.  A variety  of  learning  resources  will  be  identified  for 
the  physician  to  utilize,  ranging  from  personal  mentors, 
computer-based  learning,  class  lectures,  skill  development 
and  communication  training. 


Colorado  Medicine  for  March,  1993 


109 


News 


CU  creating 
doctors  for  rural 
Colorado 

Although  recruitment  programs 
are  already  underway  to  meet  the 
demand  for  rural  family  doctors  in 
Colorado,  CU  School  of  Medicine 
Dean  Richard  Krugman,  MD  wants 
to  create  a formal  policy  giving 
preference  to  applicants  from  rural 
communities.  Two-thirds  of  Colo- 
rado's rural  counties  have  too  few 
doctors,  and  six  have  none  at  all.  "I'd 
like  to  see  preference  given,  between 
applicants  otherwise  equal,  to  those 
from  rural  areas,"  says  Dean  Krug- 
man. Medical  school  applicants  from 
small  towns  are  14  times  more  likely 
than  urban  applicants  to  return  to 
rural  areas  to  practice. 

Colorado  Proctor 

Availability 

Program 

By:  Paul  R.  Radway , M.D.,  F.A.C.S. 
President,  Colorado  Chapter,  Ameri- 
can College  of  Surgeons 

"(Prok'  - ter).  An  examination 
supervisor." 

The  Colorado  Chapter  is  pleased 
to  announce  and  publicize  its 

Colorado  Proctor  Availability 
Program. 

The  need  for  competent  quali- 
fied proctors  throughout  the  state 
would  seem  to  be  both  urgent  and 
acute.  Laparoscopic  surgery  has 
brought  the  need  for  proctors  to 
assist  in  hospitals'  credentialing 
efforts  to  the  fore,  but  all  new 


technologies  and  techniques  in  the 
operating  room  lend  themselves  to 
proctoring.  Because  of  a recognized 
need  by  hospitals  throughout  the 
state,  the  Colorado  Chapter  has 
initiated  the  proctoring  program  in 
order  to  identify  and  supply  compe- 
tent proctors  to  those  hospitals  that 
request  it. 

Applications  will  be  made  to  the 
Colorado  Chapter  and  will  include  a 
check  of  credentials  (similar  to  that 
which  hospitals  employ  when  they 
are  privileging  new  surgeons)  along 
with  a list  of  procedures  that  the 
applicant  feels  qualified  to  proctor 
and  an  indemnification  of  the 
Colorado  Chapter  for  its  efforts.  The 
Chapter  will  screen  applicants  and 
match  qualified  proctors  to  hospitals' 
requests. 

It  is  anticipated  that  the  hospital 
will  pay  the  proctor  a stipend  for  his 
time,  plus  expenses. 

This  program  is  intended  to 
proctor  a surgeon  in  a given  proce- 
dure or  procedures,  and  is  not 
intended  to  offer  teaching,  assistant 
services,  or  provide  patient  care.  A 
report  will  be  used  by  the  hospital 
which  will,  of  course,  be  confiden- 
tial— and  may  be  used  by  the 
hospital  in  its  credentialing  proce- 
dure. 

Surgeons  interested  in  making 
application  for  the  proctoring 
program  should  call  or  write  the 
Chapter  office.  The  address  is: 

P.O.  Box  4834 
Englewood,  CO  801  55 
Phone:  (303)  770-6048 
FAX:  (303)  771-2550 
It  is  felt  that  hospitals  will 
recognize  and  utilize  this  service  as  a 
means  of  assisting  them  in  creden- 


tialing. The  Colorado  Chapter  is 
responding  to  the  need  of  hospitals 
in  hopes  of  betterment  of  surgical 
care  for  patients  throughout  the  state. 

Symposium  to 
Probe  Health 
Effects  of  Radiation 

The  University  of  Colorado  School  of 
Medicine  and  the  Center  for  Environ- 
mental Journalism  are  co-sponsoring 
a symposium  entitled,  "Rocky  Flats 
Health  Risks:  the  Science  Behind  the 
Issues"  March  1 3.  The  symposium 
will  explore  and  discuss  the  scientific 
basis  and  issues  in  reconstructing 
public  exposures  and  health  risks 
from  past  Rocky  Flats  operations. 

Ellen  Mangione,  MD  will  present 
an  overview  of  the  state's  Rocky  Flats 
health  studies  and  Dr.  James  Rutten- 
ber  of  the  CU  Department  of  Preven- 
tive Medicine  and  Biometrics  will 
debate  Dr.  David  Ozonoff  of  the 
Boston  University  School  of  Public 
Health  on  the  question  of  whether 
epidemiology  or  risk  assessment  is 
the  best  technique  for  evaluating 
health  effects. 

The  program  will  also  address 
the  investigation  of  nuclear  facilities 
on  the  question  of  whose  facts  you 
can  trust;  atmospheric  models  and 
their  reliability  from  global  warming 
to  Rocky  Flats;  and  a comparison  of 
Chernobyl  and  U.  S.  nuclear  facili- 
ties— what  are  the  effects  of  radiation 
exposure? 

To  register,  call  (303)  232-1966 
and  for  more  information  about  the 
Rocky  Flats  health  studies  call  (303) 
692-2640. 


110 


Colorado  Medicine  for  March,  1993 


Classified  Advertising 


Publication  of  any  advertisement  in  Colorado  Medicine  is  not  an  endorsement  by  the  Colorado  Medical  Society 
of  the  product  or  service.  Colorado  Medicine  magazine  is  the  official  journal  of  the  Colorado  Medical  Society,  and 
is  authorized  to  carry  General  Advertising. 


♦ PROFESSIONAL  OPPORTUNITIES 


O'CONNOR  & ASSOCIATES— Medical 
Management  Consulting.  Services 
include:  free  initial  consultation, 
financial,  personnel  and  contract 
management;  planning  & implementing. 
William  j.  O'Connor,  PhD,  7436  S. 
Clarkson  Cir.  Littleton,  CO  80122 
(303)  797-8611  3/0293 


BC/BE  DIAGNOSTIC  RADIOLOGY— 
Immediate  opening  for  Diagnostic  Radi- 
ologist with  skills  in  MR!  & Interventional. 
Join  a growing  3-4  physician  practice  in 
1 00  bed  community  hospital  45  miles  north 
of  Denver.  Attractive  compensation 
package  with  track  to  partnership.  Send  CV 
to  Donald  Cornforth,  MD,  P.O.  Box  238, 
Loveland,  CO  80539  or  contact  Sharon  at 
(303)669-7916.  4/1192 

GENERAL  SURGEON  needed  to  join 
compatible  staff,  small  VA  medical  center 
in  Cheyenne,  WY.  Laparoscopic,  vascular/ 
thoracic  surgery  beneficial.  Competitive 
salary/benefits.  Ideal  location  with  varied 
recreational  activities  — hunting,  fishing, 
skiing  and  camping.  2 hrs.  from  Denver. 
CME  opportunities,  theater,  arts  and 
professional  sports.  Affiliation  with  U of 
Colorado  possible.  Local  community 
college.  U of  Wyoming  only  1 hr  away. 
Excellent  public  education  system,  low 
crime,  low  cost  living  — no  state  income 
tax.  Send  CV/resume  to  Mike  Lee  (11  A), 
VA  Medical  Center,  2360  E Pershing  Blvd, 
Cheyenne  WY  82001,  or  call  (307)  778- 
7307.  4/1192 

EMERGENT/URGENT  CARE  PHYSICIAN 
Full  and  part  time  position  in  Lafayette. 
Flexible  scheduling.  Send  CV  or  Contact 
Dr.  Coryell,  Community  Medical  Center, 
2000  W.  S.  Boulder  Rd.,  Lafayette,  CO 
80206,  (303)  666-4357.  1 2/0892 

WANTED:  OPEN-MINDED  GENERAL 
PRACTITIONER  to  perform  evaluations  in 
multi-specialty  office.  Part  time,  flexible 
hours,  hourly  rate.  Call:  721  -7947  and  ask 
for  Dr.  K. 


TIRED  OF  THE  DAY  TO  DAY  HASSLE  of 

HMO's,  Medicare,  discounted  insurance 
and  beingon  call?  Then  considera  position 
with  corrections.  Before  you  say  "No  Way," 
call  us  and  find  out  more.  Contact  Roderic 
Gottula,  MD,  10900  Smith  Road,  Denver, 
CO  80239  or  call  (303)  375-2110.6/0193 

FULL  TIME  BE/BC  PHYSICIAN  NEEDED 

for  Family  Practice  Group,  seeking  6th 
physician.  Wei!  established  practice, 
excellent  location  with  large  Pediatric  and 
young  adult  population.  Active  staff  at  local 
Family  Practice  oriented  hospital.  No  OB. 
Guaranteed  base  salary  with  incentive, 
excellent  benefits  and  ample  vacation. 
Optimal  life-style  is  a priority  in  this  practice. 
Please  contact:  Karen  Johnson  MD,  1 1 550 
N.  Sheridan.  Broomfield,  CO.  80020 
(303)  465-2373.  1/0393 

FAMILY  PRACTICE  OPPORTUNITY  IN 
CANON  CITY 

We  need  one  family  physician  to  practice 
in  the  Climate  Capital  of  Colorado. 
Privileges  at  St.  Thomas  More  Hospital, 
obstetric  services  desirable  but  not  required. 
Unlimited  opportunities  for  recreation. 
Growing  community.  Formore  information, 
please  call  or  write  Gary  Alan  Mohr,  MD, 
FAAFP,  730  Macon  Avenue,  Canon  City, 
CO  81212,  (719)  275-1618  Tfn/0892 

FAMILY  PRACTICE— HOSPITAL  SPON- 
SORED  CLIN  1C  OPPORTUNITY.  Dynamic, 
growth  oriented  hospital  in  beautiful  North 
Central  Wisconsin  is  seeking  Family 
Physicians  to  respond  to  growing  com- 
munity demand.  The  administrative  burdens 
of  medical  practice  will  be  minimized  in 
this  hospital  managed  clinic.  The  hospital 
has  committed  to  an  income  and  benefit 
package  which  is  significantly  higher  than 
similar  opportunities.  Package  includes 
base  income,  incentive  bonus,  malpractice, 
disability,  signing  bonus  and  student  loan 
reduction/forgiveness  program.  All  re- 
location costs  will  be  borne  by  the  hospital. 
Please  contact  Kari  Wangsness,  Associate, 
The  Chancellor  Group,  Inc.,  France  Place, 
Suite  920,  3601  Minnesota  Drive, 
Bloomington,  Minnesota,  55435,  (612) 
835-5123.  tfn/1190 


FAMILY  PHYSICIAN  needed  full  time  to 
practice  in  great  Lakewood  location.  Duties 
include  family  practice  medicine  excluding 
OB  and  inpatient  hospital  work.  Four 
physician  call  group.  Excellent  comp- 
ensation package.  Please  contact  Shirley 
Lewis,  Porter  Hospital,  (303)  778-5691. 

2/1292 

LOCUM  TENENS...  new  adventures,  free 
from  administrative  tasks,  flexibility,  and 
high  earnings.  Assignments  vary:  one  day, 
one  week,  one  month,  long  term,  OR,  time 
off  with  peace  of  mind,  knowing  that  your 
practice  goes  uninterrupted.  Qualified 
physicians  are  ready  to  assist.  Ten  years 
experience;  physician-managed  company. 
Cali  INTERIM  PHYSICIANS  today  for 
details. — Denver691  -071 8,  or  1 -800-669- 
0718  12/1292 

BOULDER-  AMBULATORY  CARE  CLINIC- 
Family  Medicine/Emergent  Care/Occu- 
pational Medicine  - Busy,  two  physician 
practice  seeking  full  time  BE/BC  Family 
Practitioner  to  join  growing  comprehensive 
medical  practice  in  prime  SE  Boulder  area. 
New,  well  equipped  facility.  Minimal  call. 
Flexable  scheduling.  Send  CV  and  call  Dr. 
Turnbow,  4800  Baseline,  D-106,  Boulder, 
Co  80303  (303)  449-4800.  3/0293 

DIAGNOSTIC  RADIOLOGY  POSITION, 
CRAIG,  CO.  1st.  Yr.  1 10k,  Benefits,  6 weeks 
off:  2nd  Yr.  120k,  Benefits,  8 weeks  off. 
Equal  shares  thereafter.  Reply;  Royal  Smith, 
MD.  Memorial  Hosp.  785  Russell  St.  Craig, 
Co.  81  625  or  call  (303)  945-6535  ext.  312, 
Days  or  945-8296  evenings.  3/0293 

PHYSICIANS,  SURGICAL/ANESTHESI- 
OLOGY RESIDENTS,  (MD/DO).  Excep- 
tional part-time  practice.  Colorado  and 
Nationwide.  Outstanding  fringes,  educ. 
assistance.  Air  National  Guard.  Call  Edd 
(307)772-6185.  9/0293 


1 1 1 


Colorado  Medicine  for  March,  1993 


c 


lassified  Advertising 


Estes  Park  Medical  Center  is  seeking  a BC 
internist.  Selected  candidate  will  locate  in 
new  clinic  adjacent  to  hospital  and  will 
join  another  internist,  F.P.  and  pediatrician. 
Financial  support  provided  through 
contract  agreement.  Send  C.V.  to  Andrew 
Wills,  CEO,  E.P.M.C.,  Box  2740,  E.P.,  CO 
80517. (303) 586-9513.  1/0393 

MEDICAL  DIRECTOR—  The  Attachment 
Center  at  Evergreen  has  an  appealing 
opportunity  for  a child  psychiatrist  to  serve 
as  Medical  Director  for  the  program.  The 
Attachment  Center  at  Evergreen  (A.C.E.)  is 
a licensed,  nationally  recognized  non-profit 
private  treatment  program  for  troubled 
children.  Our  program  is  specifically 
designed  to  relate  to  the  needs  of  children 
ages  thirteen  and  under.  We  have 
successfully  treated  hundreds  of  emotion- 
ally and  behaviorally  disturbed  children 
since  our  inception  in  1 972.  Our  treatment 
program  is  comprehensive  in  nature  and 
specialized  by  design.  As  Medical  Director, 
the  ch  i Id  psychiatristwill  enjoy  this  unique, 
effective  program  and  clinical  team 
approach  to  treatment  of  latency  age 
children  from  throughout  the  United  States. 
The  program  will  pay  the  psychiatrist's 
hourly  consultation  fee,  whileallowingthe 
physician  to  pursue  other  private  practice 
interests  in  the  community.  This  position 
offers  many  of  the  positives  of  predictable 
employment  income  withoutthe  restrictions 
and  endless  administrative  meetings 
associated  with  many  hospital  settings.  This 
position  pays  approximately  $4,000.00  per 
month  and  requiresapproximatelyoneday 
per  week.  Evergreen,  Colorado  is  a beautiful 
mountain  community  35  miles  southwest 
of  Denver.  Interested  candidates  should 
send  resume  to:  The  Attachment  Center  at 
Evergreen,  Attn:  David  M.  Hollingsworth, 
M.S.W.,  Program  Manager,  P.O.  Box  2764, 
Evergreen,  CO  80439.  An  Equal  Op- 
portunity Employer  M/F/H/V  1/0393 


♦ SITUATIONS  WANTED 

EMERGENCY  MEDICINE  work  by  M.D.- 
ER  Physician.  Experience:  25  yrs.  combined 
Er/minor/urgent  center.  Desire:  Personal 
contract  with  hospital  or  group  operating 
hosp.  ER  &/or  Minor/Urgent  center.  Salary 
& Ins.-negotiable.  Write:  Box  F.  C/O. 
Colorado  Medical  Society,  P.O.  Box  1 7550, 
Denver  CO  8021 7-0550.  4/0293 

MEDICAL  OFFICE  MGR/TRANSCRIBER/ 
EXEC  SEC'Y  :Seeks  career  with  growing 
corp  that  appreciates  outstanding  em- 
ployees. Prominent  career  background. 
Serious  inquiries  only:  Excellent  Ref's.  Call 
Patti,  233-5075.  1/0393 

♦ PROPERTIES  FOR  SALE  OR  LEASE 

Professional  Office  Space 

Excellent  location  in  Wash  Park/DU  area. 
Share  common  pt.  waiting  room  w/  2 
internists  and  1 DDS.  Three  10'  X 1 01  ops, 
reception  area.  Very  reasonable.  Call  Russ, 
688-8976.  12/0792 

MAUI,  HAWAII.  Luxurious  2BR/2BA, 
2,100  sq.ft,  condominium  in  Kaanapali 
Beach  Resort,  100  yards  from  beach. 
Everything's  new!  Pool,  Jacuzzi,  Sauna, 
Lighted  Tennis  Courts,  Maids.  On  16th 
fairway  of  the  Royal  Kaanapali  Golf  Club. 
Special  Spring/Summer  Rates.  Call  985- 
9531.  6/0393 

EAGLE/VAIL  fully  equipped  luxury 
townhouse  on  golf  course,  4 bedrooms,  3 
baths,  reasonable  summer-winter  rates. 
Peter  Gehret,  MD  (303)  771  -0456. 

1 2/0492 

VAIL  FOR  SALE-  50%  interest  in  3500  sq. 
footvacation  homeabovethe  Westin  Hotel. 
5 bedrooms,  3.5  baths,  4-car  garage, 
jacuzzi,  large  decks,  walk  to  Westin  lift. 
Call  Doug  Kirkpatrick.  Evenings  (303)  762- 
9050.  4/0193 


FOR  SALE:  Medical  Office  Building  located 
in  the  beautiful  Mtn.  community  of 
Woodland  Park,  Co.  18  Mi.  to  Colorado 
Springs  and  25  Mi.  to  Cripple  Creek.  Sale 
necessary  due  to  husband's  death.  For 
information  contact  Mrs.  R.  ).  Groeger — 
1 21 0 W.  Lorraine  Woodland  Park,  Co.  or 
call  (719)  687-2687.  6/0293 

MEDICAL  OFFICE  SPACE  on  a time  share 
basis.  Central  Lakewood.  Negotiable,  1 ,000 
square  feet.  Call  Adrienne  at  758-6583. 

♦ EQUIPMENT  FOR  SALE  OR  LEASE 

BUY  DIRECT— LOCAL  MFGR.  Custom 
Office  Furniture — Desks,  Credenzas, 
bookcases,  Files,  work  stations,  waiting 
room  seating,  etc.  Oak-cherry  & walnut. 
We  build  quality  custom  office  furniture  at 
a price  you  can  afford.  Mark  IV  Systems, 
Inc.  297-1  248.  8:00-4:30  M-F.  1 2/0293 

FOR  SALE:  Multiple-station  Pulmonary 
Function  Testing  System.  Twenty  office- 
based  spirometry  units  with  volume 
spirometer,  computer  workstation,  cali- 
bration syringe  and  modem.  Centra! 
computer  facility  with  storage,  modems 
and  printer.  May  be  acquired  with  existing 
accounts  on  contract  to  provide  pul- 
monologist overread.  All  offers  will  be 
considered.  For  more  information,  contact: 
Peter  Canaday,  M.D.,  Western  Pulmonary 
Services,  501  S.  Cherry  St.  #700,  Denver, 
CO  80222.  (303)  892-0547.  3/0393 

♦ PRACTICES  FOR  SALE 

COLORADO  MTN.  RESORT  PRACTICE 
FOR  SALE.  Busy  OB.  GYN.  practice  in  the 
ski/summer  resort  of  Steamboat  Springs. 
Available  to  BC/BE  physician.  Retiring 
physician  will  transition  practice  which 
offersexcellentfinancial  return  in  a beautiful 
mountain  community.  Good  OB.  and  GYN 
call  coverage.  Please  send  C.V.  to  : Box  T. 
C/O  Colorado  Medical  Society,  P.O.  Box 
1 7550,  Denver,  CO.  80217-0550  3/01 93 


112 


Colorado  Medicine  for  March,  1993 


AURORA,  COLORADO.  Large  Family 
Practice  for  sale.  Could  be  excellent 
opportunity  for  intern ist  as  well.  Substantial 
gross  income  with  potential  for  much  more. 
Doctor  retiring.  Call  Marvin  N.  Cameron, 
M.D.  1-303-364-4553  3/1192 

FOR  SALE:  Large  Family  Practice  business 
in  Wheat  ridge.  Offering  the  building  for 
sale  as  well.  Will  make  a good  deal.  Willing 
to  finance.  Call  Eugene  Sassano  M.D.  at 
279-4924.  1/0393 

BUSY  X-RAY/MAMMO  DEPT,  for  sale  in 
Thornton,  CO.  For  more  information  call 
Bobbie  at  (303)  252-0083. 

♦ SERVICES 

QUICK  CLAIM  ELECTRONIC  CLAIMS 
PROCESSORS,  HMO  PPO,  MEDICARE, 
MEDICAID  AND  PATIENTS  BILLING  (303) 
333-8666.  22/0393 

MEDICAL  LITERATURE  RESEARCH  — 
Want  to  review  literature  for  clinical  or 
legal  problems,  presentationorpublication? 
Experienced  physician/author/educator  will 
do  customized  multiple  database  search  at 
reasonable  rates.  Call:  Bill  Milburn,  MD  at 
823-5083;  1-800-828-9259  (outside 
Boulder/Longmont).  12/0792 

HOME  MORTGAGE  LOANS 
LOW  DOC  PROGRAM  available  for 
physicians  and  other  health  professionals. 
Purchase  and  refinance.  Call  Milt,  a 
mortgage  banker  with  1 8 years  experience. 
753-6262.  12/1292 


Cash  Crunch? 

Overhead  Rising? 

Revenue  Dropping? 

Let  us  help  lower  your  costs.  YOU 
specialize  in  patient  care.  WE  specialize 
in  insurance  billing.  We  work  with 
Medicare,  Medicaid,  HMO's,  PPO's,  and 
other  third  party  carriers. 

We  don't  get  paid  until  you  get  paid. 
For  more  information  call  Advanced 
Professional  Services  (303)  755-0093. 

tfn/0492 


INOVATIONS  SHOULD  BE  PATENTED  if 

marketable.  For  more  information  call  Brian 
D.  Smith  of  Fields,  Lewis,  Pittenger  & Rost. 
Colo's  leading  patent  law  firm.  Mr.  Smith 
specializes  in  the  medical  arts.  (303)  758- 
8400.  1 2/1 1 92 

MEDICAL  TRANSCRIPTION  fast,  depend 
able,  accurate.  Most  specialties.  Call-in  or 
pick-up  available.  Excellent  references. 
Please  call  Linda  (303)  467-2641 . 1/0393 

Practice  Valuations  $38900  - Includes 
accounts  receivable,  medical  and  office 
equipment  and  furniture.  Call  Yvonne,  3- 
Minute  Reader  (1-800-848-4912  x-4401 
or  Denver  metro  756-61 08).  Out-of-metro 
include  travel  expenses.  4/0393 

♦ MISCELLANEOUS 

FOR  SALE:  Chagall's  Red  Rooster.  Price 
negotiable.  Certificate  of  authenticity  and 
references  available.  Please  send  phone 
number  and/or  address  and  I will  contact 
you.  Respond  to  Box  O care  of  Colorado 
Medicine,  P.O.  Box  17550,  Denver,  CO 
80217-0550.  1/393 

EQUIPMENT  NEEDED  URGENTLY  for 

large  community  health  center  located  in 
Longmont.  Our  five-exam  room  facility 
will  soon  expand  to  1 2 exam  rooms  and  we 
are  looking  for  good  used  office  equipment 
and  exam  room  furnishings.  Call  to  discuss 
price/donations  with  Mark  Kissack  at  (800) 
388-4325.  6/0393 


OCCUPATIONAL 

MEDICINE 

# 

EG&G  Rocky  Flats,  Inc.,  located  near 
Denver,  Colorado  is  looking  for  a 
licensed  physician. 

# 

Responsibilities  include  pre-employ- 
ment, medical  surveillance,  return  to 
work  exams,  work  related  injury  care, 
worksite  evaluations,  counseling 
employees  and  management  of  health 
risks.  Experience  in  industrial  medicine 
is  highly  desirable. 

# 

EG&G  offers  an  exceptional  compen- 
sation package.  Please  send  your 
resume  to  EG&G  Rocky  Flats,  Inc., 
Employment  Department,  MLS,  P.O. 
Box  464,  Golden,  CO  80402-0464. 
F.O.E. 

# 

EG&G 

ROCKY  FLATS 


Fly-in  Fishing  Expeditions  to  Saskatchewan,  Canada 


FOSTER  LAKE  LODGE 


Northern  Pike,  Lake  Trout,  Arctic  Grayling,  Walleye.  Full  American  Plan.  Superb 
Dining,  Deluxe  Accommodations.  For  more  information  or  video,  call  or  write: 
Wally  & John  Stuerke,  2453  Garrison  St.,  Lakewood.  CO  80215  (303)  238-3322 


Colorado  Medicine  for  March,  1993 


113 


Ruminations 


(def:  to  chew  again  what  has  been  chewed  slightly  and  swallowed;  to  REFLECT) 


by  Bill  Pierson,  Managing  Editor 


From  Colorado  Medicine,  Vol.  77, 
Number  3,  March,  1 980 

" The  Colorado  Hospital 
Commission  has  expired. 

It  was  a short  life  filled 
with  anxiety,  distrust,  and 
vast  amounts  of  paper. 

And  perhaps  it  was  the 
personalities  of  some  of 
the  original  commission- 
ers that  dealt  the  real 
death  blow.  For  whatever 
reasons , there  will  not  he 
a commission  on  March 
1st. 


The  legislation  which  created  the 
commission  was  intended  to  create  a 
Colorado  cost  containment  mecha- 
nism which  would  oppose  control  by 
proposed  federal  mandates.  The 
weakest  part  of  the  law  was  the 
failure  to  provide  enough  lead-in 
time  for  the  commission  to  hire  a 
director  and  get  itself  organized 
before  beginning  to  review  hospital 
budgets.  It  got  off  to  a disorganized 
start  and  adopted  rules  that  appeared 
not  to  comply  with  the  intent  of  the 
legislators,  especially  in  terms  of 
payment  differentials  to  third-party 
payers. 

Other  rules  omitted  growth  and 
development  funds  for  hospitals' 
future  plans,  thus  alarming  hospital 
trustees  whose  long-range  planning 
committees  had  conscientiously 
blue-printed  their  hospital's  futures. 

In  some  cases,  financial  reserves 
were  transferred  to  the  operating 
budgets. 

But  the  real  culprits  were  paper 
and  personalities.  Mounds  of  paper- 
work were  involved  in  each  review 
and  often  were  repeated  when  a 
budget  was  turned  down.  This  was 
difficult  enough  for  large  hospitals 
but  an  enormous  problem  for  small 
ones.  Add  an  adversarial  nature  to 
the  hearings,  and  you  see  what 
happened  in  the  minds  of  hospital 
administrators. 

A few  administrators  honestly 
feel  that  hospital  cost  will  continue 
to  rise  for  many  reasons,  and  that  a 
commission  does  serve  a valuable 
function.  Also,  they  continue  to  feel 
that  the  threat  of  a federal  cost 
containment  law  is  ever  present  and 
that  some  kind  of  state  commission  is 
far  superior. 


Senator  Strickland  (R),  Westmin- 
ster, chaired  the  Senate  committee  in 
which  the  bill  to  continue  the 
Colorado  Hospital  Commission  was 
debated.  In  about  one  hour  [of 
testimony  pro  and  con]  the  bill  was 
killed  on  a 6 to  2 vote. 

A tribute  should  be  given  to  the 
three  commissioners  appointed  by 
Governor  Lamm  last  summer.  Philip 
Milstein,  Mrs.  Frances  (Salty) 
Welborn,  and  Craig  Barnes  did 
everything  possible  to  abbreviate  the 
paper  forms,  put  a smile  on  the 
commission,  and  write  a new  bill 
that  could  win  approval  in  this  year's 
legislature.  They  failed  but  not  from 
lack  of  trying  - they  started  from  too 
far  behind. 

So  now  the  hospitals  of  Colorado 
have  the  awesome  opportunity  and 
responsibility  to  keep  the  increase  in 
costs  down  on  a voluntary  basis. 
Physicians  will  no  doubt  be  asked  to 
play  a role." 

Carol  Tempest 


From  The  Rocky  Mountain  News, 
Feb.  19,  1993 

Presidents  of  Presbyterian/St. 
Luke's  and  Swedish  Medical  Center 
said  Thursday  they're  considering  a 
merger,  while  a third  Denver-area 
hospital  announced  major  changes 
in  its  upper  ranks. 

All  three  institutions  are  scram- 
bling to  prepare  for  health  care 
reform  promised  by  the  Clinton  ad- 
ministration. 

Colorado  hospital  administra- 
tors expect  Clinton's  reforms  to  be 
more  than  talk.  They  are  bracing  for 
changes  expected  to  change  the  way 
hospitals  do  business. 


114 


Colorado  Medicine  for  March,  1993 


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HEALTH  SCIENCES  LIBR  \RYi 
UNIVERSITY  OF  MARYLAND 
BALTIMORE 

APR  22,1393 


NOT  IN  Cl R& 


STACKS 


cases?  masstt 


This  Issue: 

ill  health  care  demand  continue  to  increase? Leigh  Truitt ; MD 

>93  Directory  Update — Accuracy  Depends  on  YOU See  page  130 

ealth  Care  hopper  runneth  over  in  '93  legislature The  Lobby 

isponse  to  "Legislative  Alert"  on  Corporate  Practice Mary  Jo  Jacobs , MD 

iendship  Bridge  — Theodore  Ning,  MD Gil  Maestas,  II 


rigin  of  the  perceived  U.  S.  Health  Care  Crisis  ..Thomas  Golbert,  MD,  John  Ford,  III,  MD,  Lynn  Parry,  MD 


‘Doctor,  Doctor! 
Come  Quick! 
There’s  a Process  Server 


in  the  Waiting  Room!’ 


An  unlikely  scenario?  Unfortunately,  no.  Colorado 
physicians  are  on  the  receiving  end  of  malpractice 
suits  on  the  average  of  once  every  seven  years. 
►>  The  right  response?  Accept  the  summons 
or  subpoena,  then  pick  up  your  phone  and 
call  Copic  Insurance  Company  Headquarters, 
which  is  right  here  in  Colorado.  The  damage 
control  will  start  immediately,  and  you’ll 
feel  better  in  the  morning.  ❖ But,  you  say, 
what  if  the  targeted  physician  is  one  of  the 
minority  in  Colorado  who  didn’t  choose  Copic? 

♦♦♦  Well,  maybe  he  or  she  won’t  feel  better  in  the  morning. 

The  Copic  Bottom  Line.  It’s  more  than  just  competitive  rates. 


(opic 


Copic  Insurance  Company 

RO.  Box  17540  • Denver,  CO  80217-0540  • (303)779-0044  • 1-800-421-1834 


Colorado  Medicine 

April,  1993  Volume  90,  Number  4 


Cover  Story 

Change  forthe  sake  of  change 
or  meaningful  reform?  In  this 
issue,  we  examine  the  veneer 
of  health  care  reform  to  see  if 
there  is  any  substance  be- 
neath it. 


Departments 


123  Med  Fax 

127  President's  Letter 

129  Executive  Director's  Update 

1 33  The  Lobby 

138  Health  Care  Financing 

141  Health  Department 

145  Committee  Update 

151  Guest  Editorial 

156  Classified  Advertising 

158  Ruminations 


hlii  This  Issue... 

1 27  Will  health  care  demand  continue  to  increase? 

Leigh  Truitt,  President,  1992-1993 

131  President-Elect's  Planning  Conference 

Wm.  Carl  Bailey,  MD,  President-Elect 

1 32  CMS  helps  in  fight  against  medical  indigence 

1 36  Questions  and  answers  on  OSHA  questions  and  more 

1 43  Today's  Legislators  Determine  Tomorrow's  Medicine 

148  A Friendship  Bridge  from  the  United  States  to  Vietnam 
Gil  Maestas,  11,  Colorado  Medicine  Staff  Writer 

1 52  Emergency  consultations  for  HMO-hospital  patients 

Mark  W.  Elliott,  MD 

1 54  Let's  talk  about  America's  health  care  system 

Thomas  M.  Golbert,  MD,  John  Ford,  III,  M.,  Lynn  Parry,  MD 


158 


Health  Care  Reform — Objective  reality,  verisimilitude 
or  what? 

William  S.  Pierson,  Managing  Editor 


Colorado  Medical  Society 


COLORADO  MEDICAL  SOCIETY 
OFFICERS,  BOARD  MEMBERS  and  AMA  DELEGATES 


1992/1993  Officers 
Leigh  Truitt,  M.D. 

President 

Wm.  Carl  Bailey,  MD 

President-elect 

Terrance  J.  Sullivan,  M.D. 

Treasurer 

Stuart  O.  Silverberg,  M.D. 

Speaker  of  the  House 

David  C.  Martz,  M.D. 

Vice-speaker  of  the  House 

Sandra  L.  Maloney 

Secretary/Executive  Director 

Harrison  G.  Butler,  III,  M.D. 

(Immediate  Past  President) 


Board  of  Directors 

Board  of  Directors 

Thomas  J.  Allen,  MD 

Dieter  W.  Schneider,  MD 

Stephen  G.  Batuello,  MD 

David  Shander,  MD 

John  O.  Cletcher,  Jr.,  MD 

W.  George  Shanks,  MD 

Donald  G.  Eckhoff,  MD 

Susan  A.  Sherman,  MD 

John  E.  Elliff,  MD 

Gary  D.  VanderArk,  MD 

Jonathan  C.  Feeney,  MD 

Denis  J.  Winder,  MD 

David  C.  S.  Franklin,  MD 

M.  Robert  Yakely,  MD 

Joel  M.  Karlin,  MD 

George  M.  Kreye,  MD 

AMA  Delegates 

Muryl  L.  Laman,  MD 

Ted  T.  Lewis,  MD 

M.  Ray  Painter,  Jr.,  MD 

Maura  J.  Lofaro,  MS  IV 

Richert  E.  Quinn,  Jr.,  MD 

Louise  L.  McDonald,  MD 

Mark  A.  Levine,  MD 

Robert  R.  Montgomery, 

Legal  Counsel 

Alternate  Delegates 

Robert  A.  Nathan,  MD 

Kenneth  M.  Olds,  MD 

Robert  D.  McCartney,  MD 

Lothar  K.  Roller,  MD 

Robert  M.  Bogin,  MD 

Joel  M.  Karlin,  MD 

COLORADO  MEDICAL  SOCIETY  STAFF 


Executive  Office 

Sandra  L.  Maloney,  Executive  Director 
Mary  Lee  Johnston,  Executive  Admin.  Asst. 
Nancy  L.  Deter,  Manager,  Accounting 


Division  of  Health  Care  Policy 

Ellen  J.  Stein,  Director 

Marilyn  P.  Barton,  Program  Manager 

Lynn  R.  Livingston,  Administrative  Assistant 


Western  Slope  Office 

Dolores  M.  Bennett,  Executive  Secretary 

Division  of  Membership  Information  Services 

Timothy  H.  Roberts,  Director 
Diane  L.  LeHew,  Manager,  Support  Services 
Debra  M.  Jones,  Membership  Coordinator 
Beth  M.  Crusha,  Administrative  Assistant 


Division  of  Health  Care  Financing 

Edie  K.  Register,  Director 

Marijo  M.  Parkin,  Program  Manager 

Division  of  Government  Relations 

Sue  Ellen  Quam,  Director 

Lorraine  L.  Koehn,  Program  Manager/Lobbyist 

K.  Suzanne  Hamilton,  Administrative  Assistant 


Division  of  Professional  Services 


Division  of  Communications 


Sandra  M.  Finney,  Director 
Lorraine  K.  Heth,  Program  Manager 
Kirsten  E.  Regalado,  Secretary 


William  S.  Pierson,  Director 

Michael  P.  Thompson,  Communications  Spec. 

Gil  Maestas  II,  Communications  Staff 


COLORADO  MEDICINE  (ISSN-01 99-7343)  is  published  monthly  as  the  official  journal  of  the  Colorado  Medical  Society,  7800  E.  Dorado  PI.,  Englewood,  CO  801 1 1 . Telephone  (303)  779-5455.  Outside 
Denver  area,  call  1 -800-654-5653.  Second  Class  postage  paid  at  Englewood,  Colorado,  and  at  additional  mailing  offices.  POSTMASTER,  send  address  changes  to  COLORADO  MEDICINE,  P.  O.  BOX 
1 7550,  Denver,  CO  80217-0550.  Address  all  correspondence  relating  to  subscriptions,  advertising  or  address  changes,  manuscripts,  organizational  and  other  news  items  regarding  the  editorial  content 
to  the  editorial  and  business  office.  Subscriptions  are  available  for  $30  per  year,  paid  in  advance. 

COLORADO  MEDICINE  magazine  is  the  official  journal  of  the  Colorado  Medical  Society,  but  as  such  is  also  authorized  to  carry  general  advertising.  Publication  of  any  advertisement  in  COLORADO 
MEDICINE  does  not  imply  an  endorsement  or  sponsorship  by  the  Colorado  Medical  Society  of  the  product  or  service  advertised.  Published  articles  represent  opinions  of  the  authors  and  do  not  necessarily 
reflect  the  official  policy  of  the  Colorado  Medical  Society  unless  clearly  specified. 

Sandra  L.  Maloney,  Executive  Editor;  William  S.  Pierson,  Managing  Editor;  Michael  Thompson,  Asst.  Managing  Editor 


Member,  Colorado  Press  Association, 


Member,  Colorado  Broadcasters  Association 


120 


Colorado  Medicine  for  April,  1993 


CMS  Med  Fax 

® 


AT  PRESS  TIME... 

...a  compilation  of  medically-related  news  briefs  of  immediate  interest  to  the  physician  community  occurring 
after  COLORADO  MEDICINE  has  gone  to  press. 


CMS  Med  Fax„ 

by  Montgomery  Little  and  McGrew,  P.C. 

legal  counsel  to  the  Colorado  Medical  Society 


Speaker  Confirmed  for  IM  ‘93 

Think  Tank  Chief  to  Address  Health  Care  Reform 


(March  23,  1993)  Philip  M.  Burgess,  president  of 
the  Center  for  the  New  West,  today  agreed  to  address 
the  membership  of  the  Colorado  Medical  Society  at  the 
Interim  Session.  Mr.  Burgess’s  qualifications  range  from 
participation  in  President  Clinton’s  economic  “summit” 
in  December  to  teaching  public  policy,  management 
and  resource  economics  at  Ohio  State  University, 
University  of  Colorado  and  the  Colorado  School  of 
Mines. 

He  is  chief  executive  of  his  own  small  business, 
advising  clients  in  the  U.S.,  Europe  and  Asia.  This 
builds  on  his  experience  as  a Fullbright  Scholar  who 
worked  in  Norway,  Sweden,  Finland  and  the  Soviet 
Union. 


Dr.  Burgess  (PhD  from  American  University  in 
Washington,  DC)  served  as  executive  director  of  the 
Federation  of  Rocky  Mountain  States,  president  of  the 
Western  Governors’  Policy  Office  and  as  a member  of 
the  U.S.  Department  of  State  European  Advisory 
Council.  He  also  writes  a weekly  column  on  politics  and 
business  for  the  Rocky  Mountain  News  which  is  distrib- 
uted nationally,  and  is  a frequent  commentary  on  public 
radio  and  television. 

Philip  Burgess  will  speak  on  “Health  Care  Reform: 
Bad  Medicine  that  will  Go  Down  Hard”  at  the  Interim 
Meeting,  Saturday  morning,  April  3 in  Colorado  Springs. 
For  more  information  or  a registration  form,  call  (303) 
779-5455  or  1-800-654-5653,  ext.  415. 


Cardiopulmonary  Resuscitation  (CPR)  Directives 


Effective  January  1,  1993  Colorado  Revised 
Statute  15-18.6-101  was  amended  to  provide  for 
Advance  Directives  regarding  Cardiopulmonary  Resus- 
citation (CPR).  The  Colorado  Board  of  Health  has 
developed  rules  and  protocols  consistent  with  the 
statute  and  has  contracted  with  the  Colorado  Medical 
Society  to  implement  the  program. 

Unlike  other  advance  directives  which  may  be 
completed  in  full  by  the  patient  or  which  an  attorney 
may  assist  in  preparing,  CPR  Advance  Directives  must 
be  signed  by  a physician.  The  forms  will  only  be 
available  through  physicians  offices  and  licensed  health 
care  facilities.  CMS  is  developing,  to  be  available  by 
May  1,  1993,  the  following: 


• CPR  Advance  Directive  Forms  - Two  types 
will  be  available,  one  which  the  declarant  signs 
and  one  that  can  be  signed  by  an  agent. 

Forms  will  be  pre-numbered. 

• Informational  Packet  for  Physicians  - 
Physicians  most  likely  to  need  these  forms  will 
be  sent  a packet  of  information  which  will  help 
them  counsel  their  patients. 

• CPR  Advance  Directive  Bracelet  and  Neck- 
lace - CMS  has  contracted  with  a vendor  who 
will  supply  CPR  Advance  Directive  necklaces 
or  bracelets  to  patients.  An  order  form  will  be 
provided  with  the  CPR  Form. 

If  you  have  any  questions  prior  to  receiving  the 
information  packet  please  contact  Diana  Wood  or 
Marilyn  Barton  at  CMS  for  additional  information. 


Colorado  Medicine  for  April,  1993 


123 


Med  Fax: 
Medico- 
Legal  News 

by  Karen  B.  Best,  esq.,  an  associate  with  the  firm  of 
Montgomery  Little  & McGrew,  PC.  This  column  is  not 
legal  advice,  but  is  for  general  information  only.  For 
help  with  specific  problems,  readers  should  consult  an 

attorney. 

Emergency  Medical 
Treatment  and  Active  Labor 
Act  of  1986: 

The  Anti-Dumping  Statute 

The  Act,  commonly  referred  to  as  the  “anti-dump- 
ing” statute,  has  been  the  subject  of  several  lawsuits 
since  enactment.  The  statute  prohibits  hospitals  from 
transferring  patients  who  “come  to  a hospital”  emer- 
gency room,  without  first  providing  an  appropriate 
medical  screening  examination  and  stabilizing  the 
patient.  Recent  cases  define  the  reach  of  the  Act  and 
the  circumstances  under  which  patients  can  sue 
hospitals  or  physicians  for  alleged  violations  of  the 
statute. 

In  a recent  case  a plaintiff  sued  the  University  of 
Chicago  Hospital  under  the  Act,  claiming  that  a dis- 
patcher at  the  Hospital  failed  to  direct  an  ambulance 
carrying  her  critically  ill  infant  to  the  hospital’s  emer- 
gency room,  but  instead  directed  the  ambulance  to 
another  hospital,  resulting  in  the  infant’s  death.  The  trial 
court  dismissed  the  claim,  based  upon  the  fact  that  the 
infant  never  “came  to”  the  hospital  emergency  room. 
Since  the  infant  had  not  “come  to”  the  hospital  emer- 
gency room,  the  hospital  was  under  no  duty  under  the 
Act  to  provide  an  appropriate  medical  screening 
examination  to  the  infant  before  sending  it  elsewhere 
for  treatment.  The  dismissal  of  the  statutory  claim  was 
recently  affirmed  by  an  appellate  court  which  refused  to 
expand  the  scope  of  the  Act  to  patients  who  never 
actually  arrive  in  the  emergency  room.  “Although  a 
hospital  could  conceivably  use  a telemetry  system  in  a 
scheme  to  dump  patients,  the  statute  does  not  ex- 
pressly address  the  question  of  liability  in  such  a 
situation.”  Johnson  v.  University  of  Chicago  Hospitals, 
United  States  Court  of  Appeals,  Seventh  Circuit,  No. 
91-35-87  (December  28,  1992) 

In  a second  case,  a deceased  patient’s  brother 
sued  a treating  physician  under  the  Act,  claiming  that 
the  physician  transferred  his  sister  to  a psychiatric 
hospital  without  first  diagnosing  and  treating  a skull 


fracture  and  right  subdural  hematoma.  The  trial  court 
dismissed  the  action,  finding  that  the  Act  does  not 
permit  a private  individual  to  recover  personal  injury 
damages  from  a physician.  Instead,  the  enforcement 
sections  of  the  statute  only  permit  the  Department  of 
Health  and  Human  Services  to  sue  physicians  for 
violation  of  the  Act.  A successful  suit  by  HHS  could 
result  in  the  imposition  of  administrative  sanctions  in  the 
form  of  civil  money  penalties,  or  exclusion  from  partici- 
pation in  Medicare  programs.  In  effect,  the  plaintiff  was 
asking  the  court  to  re-write  the  Act  to  include  doctors  as 
potential  defendants.  It  refused  to  do  so. 

Here’s  the  bottom  line:  The  patient  has  to  actually 
come  to  the  hospital  emergency  room  for  the  anti- 
dumping statute  to  apply.  If  the  patient  is  merely  en 
route  and  is  directed  elsewhere,  the  patient  has  no 
claim  against  the  hospital.  If  the  patient  comes  to  the 
hospital  and  is  transferred  without  appropriate  examina- 
tion and  screening,  the  patient  may  sue  the  hospital  but 
not  the  doctor  under  the  usual  malpractice  theories. 

Revisiting  the  Question  of 
Whether  Medicare  Part  B 
Beneficiaries  may  Contract 
Privately  for  Medical 
Services 

A case  reported  in  the  February  issue  of  Colorado 
Medicine,  Stewart  v.  Sullivan,  dealt  with  the  question  of 
whether  physicians  and  patients  can  contract  privately 
for  medical  services  without  filing  a Medicare  claim.  The 
Court  found  that  there  are  no  government  policies  or 
statutes  in  effect  which  prohibit  patients  from  opting  out 
of  Medicare  on  a claim  by  claim  basis.  The  case  did  not 
decide  whether  such  a policy,  if  it  did  exist,  would  be 
lawful. 

In  the  face  of  uncertainty  created  by  the  Stewart 
opinion,  the  AMA  has  urged  physicians  to  proceed 
cautiously  in  this  area,  as  it  seeks  a clear  statement 
from  HCFA  as  to  the  government’s  position  on  opting 
out  by  Part  B beneficiaries.  “Until  that  policy  is  clarified, 
physicians  should  seek  competent  legal  counsel  prior  to 
treating  Medicare  patients  on  a private  contract  basis.” 
The  AMA  cautions  that  the  Stewart  case  alone  may  not 
offer  sufficient  justification  for  exceeding  the  limiting 
charges  for  Medicare  billings. 

(Editor’s  Note:  CMS  Director  of  Health  Care 
Financing,  Edie  Register,  strongly  recommends 
against  any  private  contracting.  It  is  likely  to  be 
vigorously  pursued  by  HCFA  and  the  carrier  and 
thus  carries  substantial  risk  of  prosecution,  even  if 
later  proved  legal.  Of  course,  if  a wealthy  patient 
(and  we’re  talking  here  about  people  who  can  afford 
to  pay  100%  of  all  health  care  costs  in  addition  to 
Medicare  premiums)  opts  out  of  Medicare  Part  B 
entirely,  this  would  eliminate  the  conflict.) 


124 


Colorado  Medicine  for  April,  1993 


CMS  Med  Fax 


What  Ever  Happened  to  the 
Arizona  Dentists  Prosecuted 
Criminally  for  Antitrust 
Violation? 

Three  dentists  made  big  news  when  they  were  the 
first  health  care  providers  in  fifty  years  to  be  criminally 
prosecuted  for  alleged  violations  of  the  Sherman  Act. 
Their  crime:  They  negotiated  jointly  on  fees  with  several 
HMO’s.  Although  the  jury  convicted,  the  trial  judge 
overturned  the  verdicts.  On  appeal  the  AMA  argued 
that  the  antitrust  laws  permit  collective  negotiation  by 
professionals  with  large  payers,  as  long  as  no  boycott 
of  the  payer  is  threatened.  The  Court  of  Appeals 
agreed. 

The  Justice  Department  decided  not  to  re-try  the 
case,  and  dismissed  charges  against  the  three  dentists. 
The  professional  corporation  of  the  principal  defendant, 
Dr.  Alston,  pled  nolo  contendere  and  agreed  to  pay  a 
$5,000  fine  and  serve  18  months  probation.  Dr.  Alston 
will  perform  250  hours  of  community  service.  This  result 
represents  a major  victory. 


Positive  Smoke-Free  Signs 

The  Colorado  Group  to  Alleviate  Smoking  Pollution 
(GASP)  has  developed  some  signs  to  help  businesses 
promote  a smoke  free  environment  in  a positive  way. 
The  small,  five  color  signs  say,  “Welcome  to  our 
smoke-free  business”  (or  store,  restaurant  or  home). 
They  are  self-adhesive  and  can  be  placed  in  a variety 
of  locations. 

The  new  signs  are  being  promoted  as  a more 
positive  and  polite  way  to  discourage  smoking,  “I  think 
eitquette  columnists  would  approve,”  says  Peter  Bialick, 
president  and  founder  of  GASP  of  Colorado.  The  new 
signs  will  be  distributed  all  over  Colorado,  though 
Bialick  cautions  that  local  ordinances  may  still  require 
specific  wording  on  traditional  “no-smoking”  signs  as 
well. 

GASP  is  also  working  on  an  updated  edition  of  their 


Guide  to  Smoke-Free  Dining  in  Colorado , as  over  75 
additional  restaurants  have  gone  smoke-free  since  the 
last  edition  was  printed  in  May,  1992.  35,000  copies  of 
that  guide  have  been  distributed. 

Call  692-2517  if  you  want  to  order  any  of  the  signs. 
For  information  about  GASP  or  the  restaurant  guide, 
call  444-9799  or  write  the  organization  at  2885  Aurora 

Ave  #16,  Boulder  CO  80303. 

LICENSE  RENEWAL 

All  Colorado  medical  licenses  expire  May  31,  1993. 
In  order  to  receive  the  renewal  application  physicians 
must  have  a correct  “address  of  record”  on  file  with  the 
Medical  Board.  If  you  have  moved  from  the  location 
where  you  last  received  the  Board’s  newsletter  and 
have  not  yet  updated  your  address,  please  submit  the 
change  in  writing  to:  Colorado  Board  of  Medical  Exam- 
iners, Attn:  Susan  Rose,  1560  Broadway,  Suite  1300, 
Denver,  CO  80202-5140.  Renewal  application  materials 
are  time  sensitive.  Do  not  rely  on  your  mail  service  to 
forward  the  packet  in  time  to  renew  your  license. 

Member  Benefit  Upgrades 

Alamo  Joins  Frequent  Flier  Program — Each  time 
a CMS  member  rents  a car  from  Alamo®,  that  member 
can  now  earn  500  frequent  flier  miles  in  conjunction 
with  a qualifying  USAir  flight.  This  brings  to  five  the 
number  of  airlines  with  which  Alamo  cooperates  in  such 
programs.  The  others  are  Delta,  Alaska,  Hawaiian,  and 
United.  CMS  members  receive  a discount  on  car 
rentals  from  Alamo®  by  calling  1-800-354-2322  24 
hours  in  advance  and  requesting  plan  BY  93238. 

INTRAV  Extends  Deadline  on  Early  Booking — 
The  Early  Booking  Bonus  deadline  for  INTRAV’s 
Passage  to  Suez  trip  has  been  extended  to  April  30, 
1993,  giving  CMS  members  an  additional  month  to 
save  $700  per  couple  on  this  exciting  adventure. 

Passage  to  Suez  includes  travel  to  Turkey,  Israel 
and  Egypt,  and  three  days  aboard  the  luxurious  Re- 
naissance. Call  CMS  at  (303)  779-5455  or  1-800-654- 
5653  if  you  need  another  brochure  on  this  or  other 
INTRAV  Adventures. 


Colorado  Medicine  for  April,  1993 


125 


CMS  Med  Fax 


Colorado  Medical  Society  provides  the  following  listings 
of  events  as  a member  service  only.  Some  events  are 
approved  for  Continuing  Medical  Education  credits. 
Information  is  provided  by  the  sponsoring  organiza- 
tions. For  more  details,  use  the  telephone  contact  at  the 
end  of  the  listing. 

Colorado  Department  of  Health 

Advances  in  Preventive  Cardiovascular  Care:  What’s 

Hot  - What’s  Not 

CME  Credit 

April  9,  1993 

Denver,  CO 

Sheraton  Denver  Tech  Center 
(303)  327-9050 

Colorado  Speech-Language-Hearing  Association 

CSHA  1993  Annual  Convention 
April  22,23,  and  24,  1993 
Radisson  Resort 
Vail,  Colorado 
(303)  753-1221 

Presbyterian/St.  Luke’s  Medical  Center 

Born  Too  Soon:  The  Perinatal  Team,  (CME  credit) 
Saturday,  April  17,  1993 
Denver,  CO 

Call  (303)  869-1900  or  1-800-633-6824 

American  Managed  Care  and  Review  Assoc.  (CME 
credit) 

May  6-7,  1993 
Forum  Hotel  Chicago 
Chicago,  Illinois 
(202)728-0506 

Colorado  Society  of  Osteopathic  Medicine 

Annual  Meeting 

CME  Credit 

June  24-27,  1993 

Sheraton  at  Steamboat 

Steamboat  Springs,  CO 

Patricia  Morales,  (303)  322-1752 


Prosper  Meniere  Society 

Symposium  & Workshops  on  Surgery  of  the  Inner  Ear 

July  20-25,  1994 

Snowmass,  CO 

Jane  Wells  (303)  788-4230 

Montgomery  Dorsey  Symposium 

The  American  Health  Care  Shakeout 
Solutions  and  Long  Term  Implications,  CME  credit 
July  29-31,  1993 

The  Westin  Resort,  Vail,  Colorado 
Greta  Douglas,  (303)  322-3515 

State  of  Colorado 

Division  of  Workers’  Compensation 

Low  Back  Pain 

Medical  Treatment  Guidelines 

March  30,  1993,  April  22,  1993  and  May  6,  1993 

Regency  Hotel,  Denver,  CO 

Faye  Boyd-  (303)  764-4355 

American  College  of  Cardiology 

2-D  and  Doppler  Echocardiography 
August  2-5,  1993 
Vail,  CO 
1-800-257-4739 

Extension,  Oklahoma  State  University 

Radiation  Safety  Specialist  Training  Program 
August  9-13,  1993 
Boulder,  CO 
(405)  744-5714 


126 


Colorado  Medicine  for  April,  1993 


Photo  by  Rocky  Mountain  News 


Leigh  Truitt , MD 
President ; 1992-1993 


President's 


Will  health  care  demand  continue  to  increase? 


! believe  that  the  demand  for 
health  care  has  reached  a plateau  in 
the  United  States,  if  the  present 
system  of  financing  health  care 
continues.  Further  increases  in 
demand  will  come  from  aging  of  the 
population  but  this  will  be  balanced 
by  lack  of  insurance  or  under- 
insurance for  many  and  by  restraints 
on  demand  by  managed  care 
organizations  for  those  who  are 
insured. 

Our  health  care  has  become  too 
expensive.  We  are  in  danger  of 
pricing  ourselves  out  of  the  market. 
We  can  no  longer  ignore  the  eco- 
nomic realities  of  the  costs  of  our 
technology  and  our  services. 

We  are  not  the  only  ones  in 
trouble  on  the  cost  side.  Helmut 
Werner,  the  new  CEO  of  Daimler- 
Benz,  has  publicly  stated  that  their 
cars  are  "over-engineered"  and  that 
"No  one  in  the  world  is  prepared  to 
pay  for  German  complacency  on  the 


cost  front."1  Similarly,  we  cannot  be 
complacent  on  the  cost  front. 

Our  fee-for-service  health  care, 
whether  the  fee  is  a per  diem  or  a 
DRG  charge  for  hospital  care,  a 
physician's  fee,  a lab  test  or  imaging 
charge,  results  in  the  fundamental 
equation  of  health  care  costs: 

COST  = PRICE  X VOLUME 

No  matter  how  much  the  price  is 
controlled,  costs  will  inevitably 
climb  unless  volume  is  also  con- 
strained. The  19%  of  the  health  care 
dollar  that  goes  to  physicians  is  not 
the  crucial  issue.  What  really  matters 
is  what  it  takes  to  get  there  — the 
associated  diagnostic  and  therapeu- 
tic procedures  through  which 
physicians  generate  their  fees.  If 
physicians  do  control  75%  to  80%  of 
the  health  care  dollars  by  their 
patient  care  decisions,  there  is  at 
least  a four-fold  multiplier  effect. 


Beginning  in  1 965 , with 
the  passage  of  the  Federal 
Medicare  and  Medicaid 
programs , we  have  experi- 
enced a period  of  steadily 
rising  demand  for  health 
care  This  has  resulted 
from  general  inflation , 
specific  health  care  infla- 
tion, changing  demo- 
graphics, higher  levels  of 
technology and  rising 
standards  of  living.  Will 
demand  continue  to  in- 
crease? 


Colorado  Medicine  for  April,  1993 


127 


resident's 


Letter 


"Somehow,  we  must  un- 
couple our  reimbursement 
from  being  directly  related 
to  the  volume  of  services. 

We  must  move  beyond 
fee-for-service. " 


If  health  care  reform  results  in 
universal  coverage  — that  is,  every- 
one has  health  insurance  in  some 
form  — we  may  see  an  explosion  in 
the  demand  for  health  are  such  as 
occurred  with  the  onset  of  Medicare/ 
Medicaid.  There  is  evidence  that 
there  are  substantial  unmet  health 
care  needs  among  the  uninsured  and 
under-insured. 

Global  budgeting  (or,  more 
accurately,  expenditure  caps)  will 
occur.  Our  society  is  in  the  process 
of  saying  that  we  will  limit  the 
resources  going  into  health  care.  This 
global  budgeting  could  take  two 
forms: 

• Global  budgets  based  on  rate 
regulation  —the  goal  for  national 
health  spending  divided  by  the 
volume  of  anticipated  services  to 
arrive  at  a national  fee  schedule 
for  health  care  services. 

• Global  budgets  based  on  pre- 
mium regulation  - the  goal  for 
national  health  spending  divided 
by  the  number  of  Americans  to 
arrive  at  a per  capita  amount  that 
insurers  could  charge  for  health 
coverage.2 

We  supported  universal  cover- 
age in  our  Resolution  74P  - Health 
Care  Reform  — and  not  just  because 
it  would  be  good  for  ourselves.  We 
also  endorsed  cost  containment  and 
high  quality  care.  In  so  doing,  we 
must  come  to  grips  with  the  implica- 
tions of  the  fee-for-service  metaphor. 
If  the  only  way  to  control  the  costs  of 
care  is  by  steadily  decreasing  the 
price,  life  will  be  unpleasant  indeed! 
Somehow,  we  must  uncouple  our 
reimbursement  from  being  directly 


related  to  the  volume  of  services.  We 
must  move  beyond  fee-for-service. 

I would  like  to  see  physicians 
take  a leadership  position  in  design- 
ing and  implementing  new  ways  of 
addressing  the  costs  of  health  care. 
We  must  constrain  the  volume  of 
health  care  services  or  appropriately 
reprice  those  services  so  that  we  are 
more  cost  effective.  Capitation, 
salaries,  and  other  forms  of  contract 
practice  all  de-couple  reimburse- 
ment from  the  volume  of  services. 
There  may  be  other  methods  as  yet 
untried. 

If  the  demand  for  health  care  is 
more  than  society  is  willing  or  able 
to  pay  for,  we  as  physicians  will  be 
in  a very  poor  position  - working  for 
less  and  less  per  unit  of  service.  We 
will  be  better  off  if  we  participate 
with  the  rest  of  society  in  determin- 
ing which  services  and  how  many  of 
them  truly  contribute  to  the  better 
health  of  our  country  — outcomes 
management.  To  be  at  risk  for  the 
costs  of  care  may  be  our  best  option. 


References: 

1 John  Templeton,  "Mercedes  Is  Downsizing 
- And  That  Includes  the  Sticker,"  Business 
Week,  p.  38,  February  8,  1993. 

2 Adapted  from  Janet  Murguia,  JD. 


128 


Colorado  Medicine  for  April,  1993 


Executive  Director's 


• What  will  Romer  and  the  legislature  do  to  medicine? 

• What  will  Clinton  and  Congress  do  to  medicine? 


The  question  is  no  longer 
whether  or  not  our  health  care 
system  is  going  to  change,  but  what 
form  it  will  take  after  the  change.. 
The  debate  has  shifted  from  universal 
access  to  cost  containment.  We  all 
heard  President  Clinton's  economic 
address.  Health  care  reform  is  being 
linked  to  deficit  reduction  and 
economic  recovery.  The  challenges 
facing  doctors  and  patients  are  the 
most  critical  in  recent  memory. 

What  is  in  store  for  us?  Well, 
CMS  members  and  staff  certainly  are 
at  the  table  seeking  an  answer  to  this 
question.  Yes,  unlike  the  tactics 
being  used  at  a national  level 
regarding  the  exclusion  of  stakehold- 
ers from  participation  in  meetings  on 
health  care  reform,  we  in  Colorado 
are  "allowed"  to  participate.  One 
must  remember  that  participation 
also  means  that  we  must  share  in  the 
blame  — regardless  of  what  hap- 
pens, someone  is  no 

t going  to  like  the  outcome. 

It  appears  that  "reformers"  have 
chosen  sides  in  the  health  care 
debate.  The  debate  is  threatening 
most  of  the  stakeholders.  When 
humans  are  threatened,  their  usual 
response  is  to  lash  out,  make  accusa- 
tions, and  point  the  fickle  finger  of 
blame  at  others.  CMS  is  being 
accused  of  being  reactive  rather  than 
proactive.  We  are  also  accused  of 
being  interested  solely  in  the  wealth 
of  physicians  rather  than  the  health 
of  patients.  When  faced  with  these 
accusations,  one  must  remember  that 


CMS  spent  a good  portion  of  1992 
obtaining  the  necessary  input  from 
its  members.  This  input  resulted  in  a 
policy  adopted  by  the  House  of 
Delegates  in  September  of  last  year. 

I submit  that  CMS  was  proactive. 

Our  policy  clearly  places  the  health 
and  welfare  of  your  patients  as  top 
priority  — well  above  the  income  of 
physicians.  I rest  my  case.  I wish 
the  "accusers"  would  do  the  same. 
Let's  get  on  with  meaningful  discus- 
sions . 

Several  members  of  CMS  are 
serving  on  Governor  Romer' s Health 
Care  Reform  Initiative  Committees. 
Some  of  these  physicians  also  serve 
on  the  CMS  Health  Care  Reform 
Committee.  Serving  on  the  Health 
Advisors  Panel  are  Drs.  Leigh  Truitt, 
Mary  Jo  Jacobs,  and  Steve  Berman; 
Doctors  Harvey  Cohen  and  Mark 
Johnson  are  on  the  Access  Commit- 
tee; on  the  Benefits  Committee  we 
have  Doctor  John  Sbarbaro;  Doctor 
Martin  Kiernan  serves  on  the 
Program  Finance  and  Economic 
Effects  Committee;  Doctors  Bonnie 
McCafferty,  Arlen  Meyers,  Virginia 
Moore,  and  David  West  serve  on  the 
Quality  Committee.  The  Cost 
Containment  Commission  has  also 
agreed  to  serve  as  an  advisory  body 
on  cost  containment  issues  relevant 
to  ColoradoCare.  On  this  Commis- 
sion are  Doctors  John  Santoro,  Leigh 
Truitt,  and  Richard  Wright.  There  is 
only  one  committee,  the  Actuarial 
Advisory  Committee,  on  which  CMS 
has  no  representation.  As  witnessed 


by  this  long  list  of  physician  volun- 
teers, it  is  evident  that  CMS  members 
are  willing  to  give  of  their  time  and 
expertise  to  help  structure  a health 
care  delivery  system  that  is  good  for 
the  citizens  of  Colorado. 

Within  the  CMS  organizational 
structure,  I have  made  a change. 
Obviously,  reform  is  of  critical 
importance  to  us  therefore,  I have 
assigned  Ms.  Jo  Parkin  to  handle  the 
subject  of  health  care  reform  and 
related  matters.  Jo  is  staffing  the 
CMS  Health  Care  Reform  Committee 
and  is  attending  as  many  of  the 
meetings  of  other  stakeholders  as 
possible.  |o  will  be  analyzing  the 
various  proposals,  comparing  them 
to  our  policy,  and  making  appropri- 
ate recommendations.  My  thanks  to 
Doctor  Bob  McCartney  and  Edie 
Register  for  making  this  restructuring 
possible.  If  any  of  you  want  informa- 
tion about  health  care  reform 
activities  please  contact  Jo. 

CMS  must  be  well  positioned  to 
advocate  the  best  interests  of  both 
physicians  and  patients  in  the 
discussions  over  health  care  reform. 
Whatever  is  in  store  for  us,  I believe 
it  is  vital  for  us  to  be  involved,  to  be 
at  the  table,  to  work  together  with 
elected  officials  and  community 
groups,  and  to  be  vocal  advocates 
for  the  profession  and  the  patients  of 
Colorado. 

Now  is  the  time  to  present  good 
ideas  and  workable  solutions,  and 
not  just  do  what  is  considered 
"politically  correct." 


Colorado  Medicine  for  April,  1993 


129 


1993  Physician's  Directory  Cards 
in  the  Mail 

The  accuracy  of  your  listing  depends  on  YOU 


Is  your  name  spelled  correctly? 


Do  we  have  your  home  and  office  addresses  and  phone  numbers  correct?  Please 
note  if  you  would  prefer  an  address  or  phone  number  be  unlisted. 


Mary  L Jones,  DO 
Office  Addiess: 

1 0643  Ridgeway  Rd 
Alamosa 
0081101(719)845-0951 


Home  Addiess: 

93  Fairway  Dr 
Del  Norte 
0081132(719)846-0211 


HAVEYOURETIREDFROMPRACTICE: YES  NO 

Specialties:  FAMILY  PRACTICE 

THORACIC  SURGERY  ^ 

We  can  list  up  to  five  special 


NEW  THIS  YEAR,  we  can  list  your  foreign 
languages.  Please  fill  in  up  to  four 


Foreign  Languages: 


Please  sign: 


Spanish 

Farsi 

Gaelic 

Indonesian 


ties.  Colleagues'  ability  to  refer 
to  you  is  determined  by  how 
accurately  you  provide  us  with 
this  information. 


Dear  Doctor: 

What  you  see  on  the  attached  card  will  be  your  listing  in 
the 

1993  CMS  PHYSICIAN  S DIRECTORY 
Medical  Office  Resource  Book. 

Please  note  that  a foreign  language  listing  has  been  added. 
This  is  very  important!  Indicate  what  languages  are  spoken  in 
your  offices.  We  can  store  up  to  four  languages. 

Make  changes  or  corrections  on  the  attached  card  and 

sign  it. 

Return  it,  with  or  without  changes,  by  April  3,  1993. 

Thank  you. 


If  you  have  already  re- 
tired, this  item  will  ask 
you  if  you  are  STILL  re- 
tired. Please  make  sure 
we  know  your  status. 


Your  signature  (not  your 
office  staff)  assures  the 
accuracy  of  your  listing 


This  is  the  printed  card 
you  will  find  in  your 
mailbox.  On  the  re- 
verse will  be  a label 
with  the  information 
above.  Please  fill  itout 
immediately  and  re- 
turn it  to  CMS.  If  you 
do  not  return  it  soon 
enough,  or  if  you  do 
not  make  certain  the 
information  is  accu- 
rate, we  will  not  be 
able  to  accurately 
update  your  record  in 
our  files.  Thank  you 
for  your  cooperation. 


130 


Colorado  Medicine  for  April,  1993 


Invitation 


to  the  Annual  CMS  President  Elect's  Planning  Conference 
Fort  Collins,  Colorado,  July  1 7-1 8,  1 993 


The  transformation  of  U.  S. 
health  care  delivery  is  expected 
to  begin  with  the  release  of  the 
Clinton  Health  Care  Plan  in  mid- 
May.  Just  eight  weeks  after  that,  the 
CMS  Annual  Leadership  Confer- 
ence will  meet,  and  doubtless  the 
administration’s  plan  will  be  a focus 
of  attention. 

This  blueprint  for  revolution  will 
apparently  contain  many  needed 
reforms  which  we  wili  welcome. 
However,  we  are  all  concerned  that 

• some  of  it  will  be  change  for 
change’s  own  sake 

• much  of  it  will  be  untried,  ridden 
with  faulty  premises 

• it  can  be  expected  to  work  only 
imperfectly,  if  at  all. 

Regardless  of  the  virtues  (or 
lack  thereof)  of  the  Clinton  plan,  our 
profession  has  arrived  at  a mile- 
stone. That  much  is  certain.  Ameri- 
can medicine  will  never  be  the 
same.  It  is  with  this  larger  issue  that 
we  must  concern  ourselves. 

During  this  period  of  revolution- 
ary transition,  our  task  will  be  to  do 
what  we  can  to  make  the  new 
system  work  for  the  benefit  of  our 
patients  and  our  communities,  while 
we  continue  to  foster  the  ideals  of 
medicine.  At  the  same  time,  how- 
ever, our  voice  and  expertise  are 
needed  more  than  ever,  but  our 
status  as  a learned  profession 
(licensed  professionals  vs.  technical 
tradesmen)  is  being  challenged. 

The  challenge  comes  from  govern- 
ment, other  providers  of  health  care, 
and  from  the  public  at  large  in  a way 
not  seen  in  the  past  century. 


It  is  critical  for  physicians  to 
come  together  now  for  thoughtful 
assessment  of  our  profession  and 
the  role  we  play  in  a complex, 
discordant,  and  very  needy  society. 

In  spite  of  limited  means,  the 
Colorado  Medical  Society  is  chal- 
lenged to  new  standards  of  provid- 
ing better  and  quicker  information  to 
our  members  and  more  thoughtful 
advice  and  counsel  to  government 
and  our  various  publics.  We  must 
develop  new  capacity  to  do  more 
sophisticated 
research, 
assessment, 
and  decision- 
making in  a 
very  com- 
pressed time 
frame.  In  short, 
we  need  to 
become  leaner 
and  cleaner, 
more  agile  and 
more  muscular. 
To  do  this  requires  our  organization 
to  change  in  an  intentional  and  self- 
conscious  manner. 

You  are  invited  and  urged  to 
attend  the  1993  President-elect's 
Planning  Conference,  where  we 
will  attempt  to  clarify  our  purposes, 
philosophy,  and  the  way  we  do 
things  in  a radically  different  envi- 
ronment. Your  Medical  Society 
needs  your  thoughtful,  creative 
ideas. 

Please  join  me  and  others  at 

the  Annual  President-elect’s 
Planning  Conference,  Fort 
Collins,  Colorado,  July  17-18, 
1993. 


“Regardless  of  the  virtues 
(or  lack  thereof)  of  the 

Clinton  plan,  our  profes- 
sion has  arrived  at  a 
milestone.  ” 


‘Your  Medical  Society 
needs  your  thoughtful, 
creative  ideas.  ” 


Wm.  Carl  Bailey,  MD 
CMS  President  Elect 


Colorado  Medicine  for  April,  1993 


131 


Photo  by  Rocky  Mountain  News 


Dear  Colleagues: 


Leigh  Truitt,  MD 

President,  Colorado  Medical  Society 


On  May  24,  1993  the  Colorado 
Medical  Society  will  host  its  first 
Golf,  Tennis  and  F ish in'  Hole  Classic 
to  benefit  a program  in  Colorado 
which  provides  medical  care  to 
indigent  patients.  We  plan  to  make 
this  an  annual  event.  Your  participa- 
tion and  support  is  necessary  to 
make  it  a success  in  its  first  critical 
year.  I want  to  encourage  you  to 
participate  in  whatever  way  best 
suits  you,  be  it  entering  a sporting 
event,  sponsoring  someone  else  in  a 
sporting  event  or  making  a donation. 

I additionally  would  invite  you  to 


help  promote  this  benefit  by  sharing 
information  about  it  with  your 
friends,  colleagues,  acquaintances 
and  the  vendors  with  whom  you 
regularly  deal. 

I look  forward  to  this  being  the 
first  in  a long  line  of  prosperous 
endeavors  by  organized  medicine  in 
Colorado  to  benefit  programs  that 
provide  care  to  the  medically 
indigent. 

Thank  you  for  your  support. 

Sincerely, 

Leigh  Truitt,  M.D. 

President 


FLIGHT  SURGEONS 
WANTED. 

Discover  the  thrill  of  flying,  the  end  of 
paperwork  and  the  enjoyment  of  a gener- 
al practice  as  an  Air  Force  flight  surgeon. 
Take  flight  with  today’s  Air  Force  and  dis- 
cover quality  benefits,  30  days  of  vaca- 
tion with  pay  each  year  and  the  support 
of  a dedicated  staff  of  professionals. 

Enjoy  a true  general  practice  on  the 
ground,  with  the  kind  of  stimulating  chal- 
lenge that  will  get  your  medical  skills  air- 
borne. Talk  to  an  Air  Force  medical  pro- 
gram manager  about  becoming  an  Air 
Force  flight  surgeon.  Call 

1-800-423-USAF 
USAF  Health  Professions 


132 


Colorado  Medicine  for  April,  1993 


by  Alan  Rapp , MD,  Chairman , Council  on  Legislation 
Sue  Ellen  Quam,  Director 
CMS  Government  Affairs  Division 
Lorraine  Koehn,  Lobbyist 


We  strongly  support  SB93-021, 
Concerning  the  responsibility  of 
health  care  coverage  entities  for  the 
activities  of  private  utilization 
review  organization  acting  on  behalf 
of  such  health  care  coverage 
entities.  Senator  Mary  Anne  Tebedo 
and  Representative  Jim  Dyer  are  the 
prime  sponsors  of  this  legislation. 

The  bill  codifies  existing  case  law  by 
making  insurers  responsible  for  the 
actions  of  private  utilization  review 
(PUR)  firms  which  provide  utilization 
services  on  their  behalf.  This  bill 
ultimately  puts  PUR  firms  under  the 
jurisdiction  of  the  insurance  commis- 
sioner since  the  insurers  they  repre- 
sent fall  under  that  jurisdiction. 

The  bill  reaffirms  the  patient's 
right  to  seek  assistance  from  the 
Commissioner  of  Insurance  regarding 
inappropriate  review  practices  which 
could  potentially  result  in  unfair 
denials. 

It  is  believed  that  passage  of  this 
bill  will  provide  an  incentive  to 
insurers,  PUR  firms,  providers  etc.  to 
work  in  a cooperative  effort  to 
develop  voluntary  guidelines  which 
could  potentially  eliminate  some  of 
the  problems  associated  with 
utilization  review.  CMS  presented 
the  Sunrise  Committee  with  reasons 
why  this  area  should  be  addressed 
last  summer.  The  Sunrise  Committee 
members  and  staff  of  Regulatory 
Agencies  believed  that  an  introduc- 
tory measure  should  be  introduced 
first  and  that  is  the  purpose  of  SB93- 
021. 

SB93-137-  Concerning  Expan- 
sion of  Anonymous  Testing  Pro- 
grams for  HIV  Infection  by  Senator 
Dottie  Wham  and  Representative 


Ken  Chlouber  passed  the  House 
Judiciary  Committee  last  week.  CMS 
supports  this  compromise  legislation. 
The  bill  states  that  the  preferred  HIV 
screening  service  is  confidential 
counseling  and  testing,  in  which  the 
individual  voluntarily  provides  the 
counselor  personal  identifying 
information.  It  authorizes  the 
Department  of  Health  to  conduct 
anonymous  counseling  and  testing 
programs  for  those  at  high  risk  for 
HIV  at  sites  selected  by  the  Depart- 
ment. It  permits  the  Department 
either  to  operate  sites  or  to  contract 
with  local  boards  of  health  to 
conduct  anonymous  sites.  Autho- 
rizes the  Board  of  Health  to  set 
performance  standards  in  order  to 
assure  the  disease  control  mission  of 
the  program  is  met.  It  allows  persons 
who  choose  anonymous  testing  to 
change  their  minds  and  provide 
personal  identifying  information. 

The  bill  does  not  affect  the  require- 
ment for  named  reporting  of  HIV- 
infected  persons  by  physicians, 
hospitals  and  private  laboratories. 

Background  Information: 

SB  157,  passed  in  1990,  directed 
the  Colorado  Department  of  Health 
to  establish  one  anonymous  testing 
site  for  persons  at-risk  for  HIV. 
Persons  wishing  anonymous  testing 
were  not  required  to  provide  their 
names,  addresses,  phone  numbers  or 
date  of  birth.  This  pilot  program  was 
launched  in  Denver  at  one  site  in 
September,  1990. 

The  purpose  of  the  pilot  was  to 
determine  whether  the  availability  of 
anonymous  (as  opposed  to  “confi- 
dential") testing  in  public  health  sites 
furthers  the  state's  ability  to  control 


On  behalf  of  patients  and 
physicians,  the  Colorado 
Medical  Society  has  spent 
the  last  month  advocating 
a wide  array  of  issues 
ranging  from  trauma  care 
studies  to  utilization  re- 
view rights  for  patients. 


Colorado  Medicine  for  April,  1993 


133 


The 


Lobby 


transmission  of  HIV  by  fulfilling  an 
unmet  need  for  those  individuals 
who  are  at-risk,  but  who  have  not 
been  tested  because  of  their  fear  and/ 
or  discomfort  regarding  disclosure  of 
personal  information. 

SB90-157  required  the  Health 
Department  to  evaluate  the  program 
and  make  recommendations  to  the 
General  Assembly  about  whether 
anonymous  testing  programs  help 
further  public  health  control  effort  for 
HIV. 

Key  Findings  of  the  Department's 
Evaluation: 

1 ) Anonymous  tests  comprised  42 
percent  of  the  total  test  performed 
at  the  three  metro  Denver  HIV 
counseling  and  testing  sites  (one 
anonymous,  two  confidential). 

2)  Estimates  are  that  between  28  and 
54  of  the  persons  who  tested 
positive  for  HIV  infection  at  the 
pilot  site  would  not  have  been 
tested  had  the  anonymous  site  not 
been  available. 

3)  Anonymous  tests  comprised  1 5 
percent  of  all  publicly-funded 
tests  during  this  period. 

4)  The  HIV  positive  test  rate  was 
higher  at  the  anonymous  test  site 
(4.8%)  than  at  the  two  metro 
Denver  confidential  test  sites 
(3.0%). 

5)  Approximately  the  same  percent- 
age of  HIV  positive  clients  at  the 
anonymous  test  site  (89.6%) 
received  their  test  results  as  at  the 
other  Denver  (89.7%)  or  state- 
wide clinics  (91 .5%).  A higher 
percentage  of  HIV  negative 
clients  received  their  results  at  the 
anonymous  site  (95.4%)  than  at 
the  other  Denver  (85.0%)  or 
statewide  sites  (85.3%) 


6)  The  process  of  notifying  sexual  or 
needle-sharing  partners  of  HIV 
positive  clients  by  public  health 
disease  control  specialists  was 
more  effective  for  clients  of 
confidential  test  sites  than  the 
anonymous  test  site. 

7)  The  evaluation  showed  there  are 
both  advantages  and  disadvan- 
tages to  anonymous  testing  and 
they  roughly  balance  each  other. 
Overall,  a limited  program  of 
anonymous  testing  may  promote 
testing  of  high  risk  persons  who 
otherwise  would  not  be  tested. 
Therefore,  personalized  counsel- 
ing would  not  be  provided  to 
these  persons  or  their  partners. 

(Information  from  the  Department  of  Health) 

SB93-086  Concerning  the 
establishment  of  a statewide  trauma 
system  by  Senator  Dottie  Wham  and 
Representative  Lewis  Entz  is  ex- 
pected to  pass  the  house  within  days. 
CMS  strongly  supports  this  legisla- 
tion. It  requires  the  Division  of 
Emergency  Medical  Services  of  the 
Department  of  Health  to  develop  a 
statewide  trauma  system  within 
existing  state  appropriations.  Autho- 
rizes the  division  to  seek  and  accept 
grants  for  development  and  opera- 
tion of  the  system.  Provides  that  the 
system  shall  promote  access  to  and 
standards  for  trauma  care,  research, 
and  communications  consistent  with 
national  standards.  It  requires  the 
division  to  submit  a plan  for  estab- 
lishment and  implementation  of  the 
system  to  the  next  general  assembly. 

HB93-1 269  Concerning  the  "Reli- 
gious Practice"  Defense  to  the 
Crime  of  Child  Abuse  was  defeated 


in  the  Senate  Judiciary  Committee. 
CMS  supported  this  legislation  and 
Carol  Jenny,  MD  testified  on  our 
behalf. 

We  believed  the  bill  would  have 
provided  an  avenue  for  children  to 
gain  access  to  medical  treatment 
while  allowing  parents  to  practice 
their  religious  belief.  The  bill  stipu- 
lated that  a child  whose  parent  does 
not  provide  medical  treatment  when 
that  child  is  in  risk  of  death  or 
serious  bodily  injury  should  be 
subject  to  legal  consequences  and 
the  courts  should  be  allowed  to 
intervene  to  save  that  child  from 
harm. 

HB93-1 151  Concerning  mea- 
sures to  increase  cooperation 
between  the  Board  of  Medical 
Examiners  and  members  of  the 
public  in  administering  the  "Colo- 
rado Medical  Practice  Act"  is 
sponsored  by  Representative  Don 
Armstrong  and  Senator  Steve  Rud- 
dick.  The  bill  gives  every  person 
filing  a complaint  against  a physician 
with  the  board  of  medical  examiners 
the  right  to  review  the  physician's 
written  answer  and  to  notify  the 
board  of  any  perceived  inaccuracies 
in  the  answer.  Requires  the  board  to 
provide  a transcript  of  its  initial 
discussions  about  the  complaint  and 
answer  to  the  person  filing  the 
complaint.  Directs  the  board  to 
include  in  its  annual  report  to  the 
general  assembly  the  number  of 
complaints  or  investigative  reports 
lodged  against  each  physician  in  the 
state.  Directs  the  board  to  make  this 
information  available  to  members  of 
the  public  who  call  or  write  to 
request  information  about  individual 


134 


Colorado  Medicine  for  April,  1993 


doctors  and  to  share  information 
with  the  national  practitioner  data 
bank.  The  bill  passed  the  House 
Health  Education  and  Welfare 
(HEWI)  Committee  and  is  now  in  the 
House  Appropriations  Committee. 

CMS  is  opposed  to  this  legisla- 
tion. Disclosing  the  number  of 
unfounded  and  dismissed  complaints 
filed  against  each  physician  licensed 
in  this  state  provides  no  useful 
information  to  consumers  and  does 
nothing  to  protect  the  public  health, 
safety  and  welfare.  The  Board  of 
Medical  Examiners  is  already 
required  to  report  specific  informa- 
tion to  the  National  Practitioner  Data 
Bank.  This  proposed  legislation 
requires  the  Board  to  submit  addi- 
tional data  to  the  NPDB  which  it  will 
not  accept.  Giving  every  person 
filing  a complaint  against  a physician 
the  right  to  review  the  physician's 
written  response  and  to  notify  the 
board  of  any  perceived  inaccuracies 
in  the  response  is  unnecessary  at  this 
stage  of  the  proceedings.  The 
purpose  of  the  complaint  is  to  alert 
the  inquiry  pane!  to  possible  acts  of 
unprofessional  conduct  on  the  part 
of  the  respondent  physician.  The 
inquiry  panel,  at  this  stage  of  the 
proceeding  does  not  resolve  the 
inevitable  inconsistencies  which 
exist  between  the  complaint  and  the 
physician's  response  thereto.  The 
inquiry  panel  assumes  the  informa- 
tion provided  by  the  complainant  is 
true.  The  respondent  physician  is 
then  given  one  opportunity  to 
respond.  The  inquiry  panel,  utilizing 
its  own  expertise,  then  determines 
what  course  of  action  to  take  regard- 
ing disposition  of  the  complaint.  To 
give  the  complainant  an  opportunity 


to  reply  to  the  physician's  response 
would  unduly  prolong  the  process, 
would  not  result  in  any  useful 
information  for  the  inquiry  panel  at 
this  stage  of  the  proceedings,  and 
may  result  in  a denial  of  procedural 
due  process  if  the  physician  is  not 
given  an  opportunity  to  rebut  the 
reply,  if  any,  filed  by  the  complain- 
ant. 

HB93-1244  -Concerning  the 
employment  of  health  care  profes- 
sionals by  licensed  or  certified 
hospitals  located  in  counties  with 
low  population,  and  in  connection 
therewith,  requiring  that  such 
hospitals  not  limit  or  control 
physicians'  independent  professional 
judgment  concerning  the  practice  of 
medicine  (has  passed  the  Senate 
HEWI  Committee  and  is  scheduled 
for  action  by  the  full  Senate)  by 
Representative  Russ  George  and 
Senator  Jim  Rizzuto.  The  bill  has 
been  significantly  amended  to 
address  many  of  our  concerns.  The 
amended  bill  now  clearly  states  that 
it  is  the  physician's  right  to  provide 
care  to  the  patient  without  interfer- 
ence from  the  hospital  regarding  use 
of  services,  facilities  and  equipment. 
It  also  now  states  that  a physician 
will  not  have  to  refer  exclusively  to 
the  hospital  and  that  any  hospital 
which  knowingly  so  limits  or  con- 
trols a physician  or  attempts  to  do  so 
shall  be  deemed  to  have  violated 
hospital  standards  of  operation  and 
shall  be  held  liable  for  such  viola- 
tions including  proximately  caused 
damages.  The  Senate  HEWI  Com- 
mittee also  amended  the  bill  to  say 
that  the  bylaws  of  any  hospital  which 
employs  physicians  shall  not  dis- 
criminate on  the  basis  of  whether  a 


physician  is  an  employee  of,  or  a 
contracting  physician  with,  the 
hospital.  CMS  was  concerned  that 
physicians  not  hired  by  the  hospital 
might  be  precluded  from  caring  for 
their  patients  within  the  hospital. 

The  bill  passed  the  Senate  HEWI 
Committee  unanimously  with  these 
amendments.  It  will  be  important  to 
retain  these  hard  fought  amendments 
as  it  appears  the  will  of  the  legisla- 
ture is  to  allow  hospitals  in  counties 
with  less  than  100,000  population  to 
directly  employ  physicians. 

HB93-1322  Concerning  health 
care  reform  by  Representative  Mike 
Coffman  and  Senator  Blickensderfer 
will  be  heard  in  the  House  Business 
Affairs  Committee  on  March  18.  The 
bill  addresses  a wide  array  of 
insurance  measures,  physician  self 
referral,  statewide  corporate  practice 
and  fee  setting  by  the  Health  Data 
Commission  for  physicians  and 
hospitals.  The  Council  on  Legisla- 
tion will  be  meeting  with  Represen- 
tative Coffman  on  March  1 7.  Please 
check  the  MED  FAX  section  of 
Colorado  Medicine  for  the  Council 
on  Legislation  and  Executive  Com- 
mittee recommendations. 


Colorado  Medicine  for  April,  1993 


135 


Questions  and  Answers 

OSHA  regulations  and  more 


compiled  by  Lynn  R.  Livingston  CMS  staff 


CMS  staff  periodically  receive  and 
subsequently  research  questions  on  a 
variety  of  topics.  Staff  agreed  that 
some  of  the  information  collected 
might  be  of  value  to  the  broader 
CMS  membership.  Accordingly, 
space  will  be  provided  in  this  and 
future  editions  of  Colorado  Medicine 
for"  Questions  And  Answers." 

Q.  A physician  related  that  he 
presently  has  two  refrigerators,  one 
for  food  and  another  containing 
hazardous  blood  products.  He 
questioned  whether  he  should  store 
oral  polio  vaccines  and  sterile 
injectables  in,  a)  the  refrigerator  with 
the  food,  b)  the  refrigerator  contain- 
ing biohazardous  material,  or  c)  did 
he  need  to  purchase  a third  refrigera- 
tor in  which  to  store  the  sterile 
injectables  and  oral  polio  vaccines? 
A.  These,  like  many  of  the 
questions  we  receive  regarding 
compliance  with  OSHA  regulations, 
are  not  specifically  addressed  by  the 
OSHA  Blood  Borne  Pathogen 
Standard.  They  fall  within  a gray  area 
and  have  more  than  one  acceptable 
solution. 

The  majority  of  people  whom  we 
queried,  including  OSHA  compli- 
ance officers,  physicians  and  infec- 
tion control  nurses  from  the  major 
metro  hospitals,  believed  that  the 
best  and  safest  of  all  possible  sce- 
narios would  be  to  have  3 refrigera- 
tors. Small  refrigerators  can  be 
purchased  at  Target  for  $1  50.00.  The 
second  best  option,  from  an  infection 
control  perspective,  was  thought  to 
be  storage  of  vaccines  and  sterile 
injectables  in  the  food  refrigerator  in 
see-through,  sealed,  tupperware-type 
containers  on  a separate  shelf  from 
food.  The  OSHA  Blood  Borne 
Pathogen  Standard  does  not  address 
the  storage  of  sterile  injectables  and 
oral  vaccines  with  food.  Lastly, 


OSHA  compliance  officers  stated 
that  sterile  injectables  and  oral  polio 
vaccines  could  be  stored  in  a 
refrigerator  with  biohazardous 
material  if  the  biohazardous  mate- 
rial, the  sterile  injectables  and  the 
oral  polio  vaccines  were  each  stored 
in  their  own  labeled,  sealed  tupper- 
ware-type container.  If,  on  the  other 
hand  a refrigerator  is  simply  desig- 
nated "Biohazardous"  and  its 
contents  are  not  housed  in  labeled, 
closed  containers,  then  oral  polio 
vaccines  and  sterile  injectables  must 
be  stored  in  a different  refrigerator.  It 
should  be  noted  here  that  all  but  one 
of  the  infection  control  nurses  with 
whom  we  talked  strongly  advised 
against  storing  medicines  in  the  same 
refrigerator  as  hazardous  blood 
products. 

Additional  OSHA  questions  may  be 
addressed  to  an  OSHA  compliance 
officer  at  844-5285. 

Q.  Is  there  a published  Standard 
which  is  used  in  determining  whet- 
her autoclaves  are  properly  working? 
A.  No.  Under  the  1 976  Device 
Amendment  to  The  Food,  Drug  and 
Cosmetic  Act,  manufacturers  of 
medical  devices  are  required  to 
provide  to  the  consumer  all  neces- 
sary information  on  how  to  operate 
and  care  for  their  products.  In  the 
case  of  autoclaves,  the  operators' 
manual  should  provide  information 
on  correct  temperatures  and  pres- 
sures. Table  top  autoclaves  generally 
come  with  a one  year  manufacturer's 
warranty. 

There  is  an  autoclave  testing  service 
in  the  metro  area,  Table  Top  Auto- 
clave Service,  778-5445.  They  will 
verify  that  the  autoclave  is  working 
properly  and  provide  repairs  when 
necessary.  The  cost  for  a table  top 
autoclave  checkup  is  between  $100 
and  $200.  They  also  check  and 


service  the  larger  autoclaves.  Type  of 
application  determines  how  fre- 
quently an  autoclave  should  be 
checked.  Most  customers  have  their 
autoclaves  checked  semiannually. 
Table  Top  Autoclave  Service  will 
provide  an  information  packet  which 
gives  more  detail  on  the  services 
which  they  provide.  Packets  can  be 
obtained  by  calling  Table  Top  at  the 
number  listed  above. 

Q.  How  should  outdated 

samples  of  noncontrol  led  substances 
be  disposed  of  by  physicians'  offices? 
A.  According  to  the  Pharmacy 

Board,  noncontrol  led  substances  can 
be  taken  out  of  their  packages  and 
flushed  down  the  toilet  or  inciner- 
ated in  their  packet.  A third  option 
suggested  (but  rarely  achieved)  was 
to  arrange  to  have  the  original 
distributor  come  pick  up  the  out- 
dated samples. 

The  Pharmacy  Board  representative 
provided  the  additional  caveat  that 
noncontrolled  substances  must  be 
disposed  of  in  a way  that  renders 
them  unrecoverable. 

Q.  What  about  the  disposal  of 

controlled  substances? 

A.  Controlled  substances  class 

2 - 5 which  a physician  wishes  to 
dispose  of  must  be  listed  on  a Drug 
Enforcement  Act  Form  41  and 
returned,  registered  mail  to  the  Drug 
Enforcement  Agency  with  2 copies  of 
the  latter  form.  Occasionally  the 
DEA  will  grant  an  individual  permis- 
sion to  dispose  of  a controlled 
substance  in  another  way.  Such 
permission  would  be  given  on  a case 
by  case  basis. 

The  address  of  the  local  DEA  office 
is:  DEA,  1 1 5 Inverness  Dr  E. 
Englewood  CO  801  12,  (303)784- 
6300 

Questions  should  be  addressed  to  a 
DEA  investigator. 


136 


Colorado  Medicine  for  April,  1993 


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& Call  Us  In  The  Morning. 


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Association  Program.  Association  members 
receive  a FREE  UPGRADE  or  a FREE  DAY  - 
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and  all  locations  are  company-owned  and 
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all  the  miles 
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As  a member,  you'll  receive  other  valuable 
coupons  throughout  the  year  that  will  save 
you  money  on  each  rental.  Alamo  - it’s  just 
what  the  doctor  ordered.  For  member 
reservations  call  your  Professional  Travel 
Agent  or  Alamo's  Membership  line  at 
1-800-354-2322.  Use  Rate  Code  BY  and 

ID# when  making 

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• (In  the  U.S.)  Valid  on  a compact  car  or  above,  excluding  premium,  luxury  and  specialty  cars. 
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excluding  group  E car  category  and  above. 

• One  certificate  per  rental.  Not  valid  with  any  other  offers.  Must  be  presented  at  the  Alamo 
counter  on  arrival.  Certificate  may  only  be  redeemed  for  the  basic  rate  of  the  car  rental.  Once 
redeemed  the  Certificate  is  void.  A 24-hour  advance  reservation  is  required. 

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time  of  rental. 

• This  certificate  is  null  and  void  if  altered,  revised  or  duplicated  in  any  way. 

• Offer  valid  through  September  30,  1993,  except  2/11-2/13/93,  4/8-4/10/93,  5/27-5/30/93, 
7/1-7/4/93  and  7/23-8/28/93. 

For  reservations  call  your  Professional  Travel  Agent  or  call 
Alamo's  Membership  Line  at  1-800-354-2322.  Request 

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when  making  reservations. 


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(In  the  United  Kingdom).  Valid  on  self-drive  rentals  from  a group  B car  category  and  above, 
excluding  group  E car  category  and  above 

1 One  certificate  per  rental.  Not  valid  with  any  other  offers.  Must  be  presented  at  the  Alamo 
counter  on  arrival.  Certificate  may  only  be  redeemed  for  the  basic  rate  of  the  car  rental.  Once 
redeemed  the  Certificate  is  void.  A 24-hour  advance  reservation  is  required. 

' This  certificate  and  the  car  rental  pursuant  to  it  are  subject  to  Alamo's  conditions  at 
time  of  rental. 

1 This  certificate  is  null  and  void  if  altered,  revised  or  duplicated  in  any  way. 

1 Offer  valid  through  September  30,  1993,  except  2/1 1-2/13/93,  4/8-4/10/93,  5/27-5/30/93, 
7/1-7/4/93  and  7/23-8/28/93. 

For  reservations  call  your  Professional  Travel  Agent  or  call 
Alamo's  Membership  Line  at  1-800-354-2322.  Request 

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36205AS 


Health  Care  Financing 


by  Jo  Parkin,  Program  Manager 
Edie  Register,  Director 

Health  Care  Financing 


Auto  insurers  inappropriately  using  Work  Comp  fee  schedule 


" It  is  the  position  of  CMS 
that  this  erroneous  use  of 
the  Workers"  Comp- 
ensation Relative  Value 
Schedule  for  this  class  of 
claims  is  inappropriate." 


Several  automobile  insurers  have 
been  using  the  Colorado  Workers' 
Compensation  Relative  Value 
Schedule  to  set  the  amounts  they  will 
pay  physicians  for  medical  treat- 
ment. CMS  has  received  numerous 
complaints  from  member  physicians 
regarding  this  practice. 

Insurance  companies  have  stated 
that  Colorado  state  law  provides  the 
authority  for  their  use  of  the  Work- 
ers' Compensation  Relative  Value 
Schedule  as  the  method  of  reimburs- 
ing physicians  for  medical  and 
surgical  care  provided  to  auto 
accident  victims.  These  companies 
are  also  advising  the  patient  not  to 
pay  any  physician  charges  in  excess 
of  the  Workers'  Compensation 
Relative  Value  Schedule. 

Colorado  state  law,  however, 
specifically  states  that  this  fee 
schedule  "will  be  used  by  insurers 
for  the  purposes  of  determining  tort 
thresholds  under  the  Colorado  Auto 
Accident  Reparations  Act."  The  rule 
does  not  state  that  insurers  can  use 
this  fee  schedule  to  determine 
reimbursement  amounts,  it  is  the 
position  of  CMS  that  this  erroneous 
use  of  the  Workers'  Compensation 
Relative  Value  Schedule  for  this  class 
of  claims  is  inappropriate. 

CMS  is  in  the  process  of  collect- 
ing specific  examples  of  auto 
insurers  using  the  Workers'  Compen- 
sation fee  schedule  as  described 
above.  The  more  examples  we  have, 
the  stronger  a case  we  can  build 
against  this  unfair  practice.  Please 
send  us  any  documentation  you  have 
regarding  claims  you  have  submitted 


which  have  been  handled  this  way. 
Documentation  should  include 
copies  of  claims  submitted  as  well  as 
vouchers  and  explanations  of 
benefit.  Please  mark  out  any  refer- 
ence that  could  lead  to  identification 
of  the  patient.  Confidentiality  must 
be  maintained  throughout  this 
process. 

Send  this  information  to:  Colo- 
rado Medical  Society,  Health  Care 
Financing  Department,  P O Box 
17550,  Denver,  CO  80217-0550 

The  Medicare 
Carrier  Advisory 
Committee  (CAC) 

Grant  E.  Steffen,  MD 
Medical  Director,  Medicare  Part  B 

Dr.  Louis  Sullivan,  the  former 
Secretary  of  Health  and  Human 
Services,  directed  each  Medicare 
carrier  last  summer  to  form  a com- 
mittee that  would  advise  the  carrier 
on  local  policies.  This  directive  arose 
from  the  Gary  Committee  report 
which  had  to  do  with  reducing  the 
"hassle  factor".  We  have  formed  this 
committee  which  had  its  first  meet- 
ing on  November  1 2,  1 992  and  its 
second  meeting  on  February  1 1 , 
1993.  Meetings  will  occur  quarterly. 

Members  of  the  Carrier  advisory 
committee  come  from  each  of  the 
major  specialties,  the  Colorado 
medical  Society,  Colorado  Hospital 
Association,  Colorado  Society  of 
Osteopathic  Medicine,  Colorado 
Foundation  for  Medical  Care, 


138 


Colorado  Medicine  for  April,  1993 


Colorado  Optometric  Association, 
Colorado  Podiatric  Medical  Associa- 
tion, Colorado  Chiropractic  Associa- 
tion, and  the  Medical  Group  Man- 
agement Association. 

While  the  CAC  may  comment 
on  national  HCFA  policies,  it  focuses 
primarily  on  the  medical  and 
administrative  policies  that  the  local 
carrier  needs  to  develop.  Before  we 
had  the  CAC  we  would  submit 
proposed  policies  to  the  involved 
specialty  societies,  the  PRO,  Colo- 
rado Hospital  Association,  and  to  the 
CMS.  This  submission  began  a 45- 
day  period  of  comment  during  which 
we  considered  changes  to  the 
policies  depending  on  comments 
received. 

This  process  has  changed.  Now, 
all  policies  will  be  submitted  to  the 
CAC,  members  of  which  have  the 
responsibility  to  disseminate  them  to 
their  constituents.  We  accept 
comments  either  from  the  CAC 
members  or  directly  from  physicians. 
These  advisory  comments  are  then 
used  to  finalize  the  policy.  The  45- 
day  period  of  comment  still  holds 
and  begins  when  the  committee 
member  receives  the  proposed 
policy. 

We  discussed  the  following 
policies  in  November.  Sargramostim 
(Leukine,  Prokine)  is  a bone  marrow 
colony  stimulating  factor  that  is 
given  to  patients  who  have  had  an 
autologous  bone  marrow  transplant. 
The  new  policy  extended  its  use  to 
include  treatment  of  neutropenia 
secondary  to  chemotherapy.  The 
committee  agreed  with  this  off-label 
use.  We  received  no  adverse  com- 
ments and  the  policy  went  into  effect 
on  October  20,  1 992,  the  date  it  was 


Health  Care 


F 


I N A N C I N 


sent  to  the  CAC  members. 

Tumor  antigens  or  markers  may 
help  physicians  diagnose  and 
manage  patients  with  a variety  of 
cancers.  The  CAC  discussed  the 
following  tumor  markers:  CA1 9-9, 
CA125,  CEA,  PSA,  and  CA15-3. 
Carrier  policy  has  restricted  payment 
for  these  antigens  to  a small  list,  and 
has  not  approved  CA1  5-3  because  of 
lack  of  FDA  approval.  The  members 
encouraged  an  expansion  of  the  lists 
of  indicators  and  an  investigation  of 
CAT  5-3. 

After  many  phone  calls  to 
Washington  and  Baltimore,  I got 
permission  to  use  carrier  discretion 
on  CA1  5-3.  I have  approved  the  use 
of  CA1 5-3  and  have  expanded  the 
indications  for  the  other  tumor 
markers.  This  new  policy  also  took 
effect  October  26,  1992. 

The  committee  also  discussed 
co-surgery  and  the  problems  that 
result  when  only  one  of  the  two 
surgeons  bill  a procedure  as  co- 
surgery. At  the  February  meeting,  the 
committee  revisited  the  co-surgery 
issue.  I pointed  out  that  the  carrier 
cannot  add  the  co-surgery  modifier  (- 
62)  to  a claim  and  cannot,  because 
of  the  enormous  work  load  involved, 
develop  each  claim  where  co- 
surgery may  have  occurred  but 
where  -62  was  not  used.  The  com- 
mittee accepted  the  carrier's  conclu- 
sion that  the  coordination  of  co- 
surgery billing  must  remain  with  the 
surgeons  involved. 

In  November,  I asked  Dr. 

Vigoda,  the  cardiologist  member,  to 
have  his  group  advise  the  carrier  on 
the  question  of  assistants  at  percuta- 
neous transluminal  coronary  ather- 
ectomy. However,  before  the 


"Dr.  Louis  Sullivan , the 
former  Secretary  of  Health 
and  Human  Services > 
directed  each  Medicare 
carrier  last  summer  to 
form  a committee  that 
would  advise  the  carrier 
on  local  policies." 


Colorado  Medicine  for  April,  1993 


139 


Health 


Care 


Financing 


" Members  of  the  Carrier 
advisory  committee  come 
from  each  of  the  major 
specialties , the  Colorado 
medical  Society Colorado 
Hospital  Association , 
Colorado  Society  of 
Osteopathic  Medicine , 
Colorado  Foundation  for 
Medical  Care , Colorado 
Optometric  Association , 
Colorado  Podiatric 
Medical  Association , 
Colorado  Chiropractic 
Association , and  the 
Medical  Group 
Management 
Association 


February  meeting,  HCFA  ruled  that 
this  procedure  did  not  warrant  an 
assistant.  Dr.  Barry  Molk,  standing  in 
for  Dr.  Vigoda,  described  how  the 
procedure  is  done,  and  stated  that 
cardiologists  almost  universally  use 
an  assistant,  and  that  this  assistant, 
should  be  a cardiologist.  I will  take 
this  issue  to  Baltimore  and  the  semi- 
annual carrier  medical  director's 
meeting  in  March. 

The  committee  also  discussed 
two  anesthesiology  issues.  First  was 
the  issue  of  paying  anesthesiologists 
rather  than  surgeons  for  post-op  pain 
management  by  epidural  catheter. 
This  carrier  had  not  been  paying  the 
anesthesiologist,  believing  that 
except  in  special  circumstances,  this 
was  the  surgeon's  task.  I raised  this 
issue  at  a January  meeting  of  all  the 
carrier  medical  directors  from  the 
western  states.  We  agreed  that  the 
interpretation  of  FJCFA's  guidelines 
allowed  payment  to  the  anesthesi- 
ologist for  this  epidural  pain  monitor- 
ing. Accordingly,  this  carrier  has 
made  this  policy  change  effective 
February  1 , 1 993. 

The  second  anesthesiology  issue 
was  monitored  anesthesia  care 
(MAC).  HCFA  has  asked  carriers  to 
recommend  procedures  for  which 
monitored  anesthesia  care  is  stan- 
dard. After  some  discussion,  we 
recognized  that  this  request  was 
presuming  that  the  use  of  MAC 
depends  on  the  patient's  status,  not 
the  procedure.  That  is,  any  proce- 
dure that  doesn't  require  general 
anesthesia  and  may  often  require 
only  a local  anesthesia  may,  because 
of  the  patient's  condition,  justify 
MAC.  I will  take  this  message  back 
to  Baltimore. 


In  February,  we  began  a discus- 
sion of  the  relatively  new  technique 
for  addressing  bone  density,  the  dual 
energy  x-ray  absorptiometry  (DEXA), 
whether  this  should  become  a 
Medicare  Benefit,  whether  it  should 
replace  the  single  photon  absorptio- 
metry, and  whether  the  old  dual 
photon  absorptiometry  should,  along 
with  DEXA,  become  a Medicare 
benefit.  Dr.  Stuart  Kassan,  rheuma- 
tologist, will  provide  the  CAC  with  a 
detailed  discussion  of  these  complex 
questions  at  the  next  meeting  in 
May.  I will  also  take  these  questions 
to  the  semi-annual  meeting  of  the 
medical  directors  in  March. 

Finally,  I asked  the  ophthalmolo- 
gists to  help  me  with  the  criteria  that 
justify  blepharoplasties  and  brow 
ptosis  correction.  I also  asked  the 
gastroenterologist  and  other  inter- 
ested members  to  help  me  to  de- 
velop indications  that  justify  a 
flexible  sigmoidoscopy.  If  you  have 
any  questions  or  comments,  you  may 
direct  them  to  me  at  (303)  831-5827 
or  to  your  representative  on  the  CAC. 

If  you  are  a member  of  a spe- 
cialty society  and  did  not  receive 
copies  of  the  above  policies,  you 
may  wish  to  talk  with  your  represen- 
tative. 


140 


Colorado  Medicine  for  April,  1993 


COLORADO 


DEPARTMENT 

OFAHEALTH 


Colorado  Department  of 


The  Colorado  Women's  Cancer 
Control  Initiative: 

A Comprehensive  Effort  to  Address  Breast  and  Cervical  Cancer 
in  Colorado  Women — Part  1 


Introduction 

The  Colorado  Women's  Cancer 
Control  Initiative  (CWCCI)  is  an 
innovative  and  comprehensive 
project  to  educate  women  about 
breast  and  cervical  cancer  and  to 
promote  screening  and  early  detec- 
tion. It  is  exciting  because  over  one 
hundred  volunteers  from  very  diverse 
backgrounds  and  communities  are 
joining  health  care  professionals 
throughout  Colorado  to  forge  a 
growing  alliance  against  breast  and 
cervical  cancer,  its  participants 
firmly  believe  they  can  make  a 
significant  impact  in  reducing 
morbidity  and  mortality  from  these 
diseases  among  Colorado  women. 

Begun  in  1991  with  grants 
received  by  the  Colorado  Depart- 
ment of  Health's  Cancer  Control 
Program  from  the  National  Cancer 
Institute  (NCI)  and  the  National 
Centers  for  Disease  Prevention  and 
Control  (CDC),  this  five-year,  multi- 
million dollar  project  is  mountain  a 
massive  public  education  program 
for  all  Coloradans  and  providing 
subsidized  screening  for  breast  and 
cervical  cancer  for  lower  income 
women. 


Background 

In  1984,  the  National  Cancer 
Institute  began  a major  initiative  to 
accomplish  the  translation  of  cancer 
prevention  and  treatment  science 
into  public  health  applications.  It 
recognized  that  state  and  local 
health  departments  form  an  impor- 
tant national  system  for  addressing 
health  issues  by  providing  direct 
personal  health  services  to  under- 
served populations  and  by  working 
with  a broad  range  of  community 
groups  and  agencies  to  promote 
important  health  education  messages 
to  all  citizens. 

Colorado  was  among  the  first 
states  to  receive  one  of  these  early 
grants,  whose  purpose  was  to 
encourage  knowledge  and  skill 
development  among  state  health 
department  staff  while  implementing 
intervention  programs  in  cancer 
prevention  and  control.  At  the  time 
of  this  award,  Colorado's  health 
department  was  already  nationally 
recognized  as  having  had  extensive 
experience  in  the  design,  implemen- 
tation and  evaluation  of  community- 
based  interventions  in  chronic 
disease  control.  This  was  very 
important  because  the  majority  of 
health  departments  were  still  empha- 
sizing communicable  disease 


by 

Carole  Chrvala,  PhD , Director, 
Cancer  Control  Program,  Colorado 
Department  of  Health 
and 

Jackie  Starr-Bocian,  Public  Relations 
Specialist,  Colorado  Department  of 
Health,  Division  of  Prevention 
Programs 


Colorado  Medicine  for  April,  1993 


141 


OLORADO 


Department  of 


Health 


prevention  and  had  limited  experi- 
ence in  working  with  chronic 
diseases  such  as  cancer. 

Colorado  was  one  of  only  seven 
states  chosen  to  participate  in  The 
Breast  and  cervical  Cancer  Mortality 
Prevention  Act  of  7 990.  It  received 
over  $1  5 million  to  conduct  a multi- 
faceted, five-year  project  whose  goal 
is  to  achieve  a dramatic  reduction  in 
mortality  among  Colorado  women 
from  breast  and  cervical  cancer. 
Through  this  funding  and  the  com- 
bined interest  of  health  care  profes- 
sionals and  women  throughout  the 
state,  the  Colorado  Women's  Cancer 
Control  Initiative  was  born. 

Breast  and  cervical 
cancer  among 
Colorado  women 

The  last  decade  has  seen  a 3% 
average  annual  increase  in  breast 
cancer  incidence  in  Colorado 
women.  In  1 992,  there  were  an 
estimated  2,300  new  cases  in 
Colorado  and  close  to  500  deaths 
due  to  the  disease.  Between  35  and 
45  percent  of  the  new  cases  will  be 
regional  or  later-stage  at  diagnosis 
with  associated  poorer  survival  rates. 
On  the  other  hand,  90%  of  women 
with  localized  disease  at  diagnosis 
will  survive  at  least  five  years  beyond 
diagnosis  and  treatment.  It  is  esti- 
mated that  two-thirds  of  women  in 
Colorado  now  comply  with  recom- 
mended intervals  for  breast  cancer 
examination  and  screening. 

Almost  1 ,000  new  cases  of 
cervical  cancer  (including  carcinoma 
in  situ)  will  be  diagnosed  in  Colo- 
rado in  1 993  and  75  deaths  will 


occur.  Only  57%  of  women  age  65 
and  over  have  regular  cervical 
screening  examinations,  including  a 
pap  smear. 

How  is  the  CWCCI 
responding  to 
breast  and  cervical 
cancer? 

The  project  involves  six  major 
activities — public  education; 
professional  education;  mammogra- 
phy and  cervical  cytology  quality 
assurance;  service  delivery  (to  pay 
for  breast  and  cervical  cancer 
screenings  for  women  who  cannot 
afford  them);  tracking  and  follow-up; 
and  surveillance. 

Putting  together  a project  of  this 
scope  is  a complex  and  involved  task 
that  requires  a unique  combination 
of  research  expertise,  skilled  data 
programming,  fiscal  stewardship, 
business  and  marketing  skills, 
cultural  sensitivity,  know-how  in 
community  organizing,  and  keen 
political  sense  to  respond  to  such 
issues  as  the  distribution  of  services 
and  awareness  of  state  and  federal 
legislative  mandates. 

Carole  Chrvala,  PhD  is  the 
overall  project  director.  She  presides 
over  a staff  of  29  in  the  Cancer 
Control  program  and  keeps  a careful 
eye  on  the  work  of  five  very  active 
committees  and  four  subcommittees 
comprised  of  staff  and  1 50  volun- 
teers. The  Women's  Health  Advisory 
Committee  is  the  body  that  provides 
oversight  and  helps  promote  the 
project. 

The  volunteers  working  on  this 


project  are  ethnically  diverse  and 
together,  form  a "who's  who"  of 
consumer  and  professional  expertise 
in  breast  and  cervical  cancer.  They 
include  individuals  with  personal 
concerns  about  breast  and/or 
cervical  cancer  and  others  represent- 
ing organizations  who  run  the  gamut 
from  cancer  research  and  health  care 
delivery  to  churches,  the  lieutenant 
governor's  office  and  professional 
organizations  including  the  Colorado 
Medical  Society. 

Project  Design 

The  major  activities  of  the  project  are 
carried  on  throughout  the  state. 

These  include  service  delivery, 
quality  assurance,  surveillance  and 
public  and  professional  education. 
Advisory  committees  oversee  each  of 
these  project  components. 

Public  Education 

Seven  areas  have  been  selected  as 
"pilot"  communities  to  test  specific 
educational  interventions,  tailored  to 
the  cultural  and  socio-economic 
characteristics  of  the  women.  In 
these  areas,  special  outreach  projects 
to  older  women,  Blacks  and  Hispan- 
ics  are  being  developed.  The  pilot 
sites  are:  Metro  Denver  (with  specific 
emphases  on  northwest  Denver, 
northeast  Denver  and  selected  areas 
in  Adams  and  Arapahoe  counties); 
the  Western  Slope  (Mesa,  Delta, 
Garfield  counties);  Northeast  Colo- 
rado (Logan,  Morgan,  Phillips, 
Sedgwick,  Washington,  Yuma 
counties);  North  Central  Colorado 
(Larimer,  Weld  counties);  Southeast 
Colorado  (Otero,  Bent,  Prowers 

to  be  continued  next  month... 


142 


Colorado  Medicine  for  April,  1993 


CCMBftC 


Today's  Legislators  Determine  Tomorrow's 

The  1 993  legislative  session  is  well  under  way,  bring- 
ing with  it  numerous  bills  which,  if  passed,  have  a tremen- 
dous potential  impact  on  physicians  in  the  state.  These 
bills  address  issues  such  as  the  corporate  practice  of 
medicine,  lay  midwifery  decriminalization  and  registration, 
additional  repercussions  for  physicians  involved  in  insur- 
ance fraud,  the  reporting  of  all  complaints  made  against  all 
physicians  to  the  National  Practitioner  Data  Bank  and  the 
list  goes  on.  With  Health  Care  Reform  a hot  issues  both  at 
the  state  and  national  level,  it  is  inevitable  that  many  bills 
will  address  this  subject. 

Today's  legislators  will  determine  how  physicians  will 
practice  medicine  tomorrow.  This  is  why  COMPAC  is  so 
vital.  COMPAC  plays  an  important  role  in  the  make-up  of 
the  General  Assembly.  This  role  can  be  fulfilled  only  if 
COMPAC  has  a large  membership  base.  Although  this  is 


Medicine 

not  an  election  year,  it  is  still  very  important  that 
COMPAC  begin  building  this  membership  base  now. 
Many  membership  recruitment  activities  have  been 
planned  for  the  next  year,  but  we  need  your  help. 

Your  job  is  two-fold.  First,  thank  the  physicians  listed 
below  which  you  have  a relationship  with  who  have 
already  joined  COMPAC.  Second,  identify  all  col- 
leges/friends/associates whose  names  do  not  appear  on 
the  membership  list  which  follows  and  encourage 
them  to  join  COMPAC's  forces  to  ensure  physicians 
have  an  environment  conducive  to  the  practice  of 
medicine  in  Colorado.  If  each  current  member  will 
recruit  one  additional  member,  COMPAC  will  be 
empowered  to  assist  in  the  election  of  legislators  who 
are  friends  of  medicine.  Please  use  the  membership 
form  provided  to  recruit  at  least  one  new  COMPAC 
member  (additional  forms  can  be  supplied  to  you). 


1993  COMPAC  Membership 


Arnold  L Ahnfeldt,  MD 

Gene  E Belles,  MD 

Randall  M Clark,  MD 

David  J Doig,  MD 

Richard  E Albin,  MD 

Jack  C Booren,  MD 

Scott  D Clark,  MD 

William  L Doig,  MD 

Bruce  H Albrecht,  MD 

Rex  C Bosley,  MD 

David  G Cloyd,  MD 

Lugene  A Dorr,  MD 

Thomas  j Alien  MD 

Janneutte  Brake,  MD 

Sally  A Coates,  MD 

lohn  W Doucette,  MD 

Sigma  Alpha,  MD 

Walter  G Briney,  MD 

Norman  G Cole  Jr,  MD 

Herman  E Doyle,  MD 

Peter  E Anderson,  MD 

James  A Britton  MD 

Jerome  S Collins  MD 

lerry  S Driessner,  MD 

A Lee  Anneberg,  MD 

Harry  Brodie,  MD 

Lily  C A Conrad,  MD 

Donald  P Elliott,  MD 

Thomas  J Arganese,  MD 

James  L Bruffy,  MD 

Donald  E Cook,  MD 

Robert  H Ellis,  MD 

Linda  D Backup,  MD 

Daniel  J Brugioni,  MD 

Daniel  R Cooper  MD 

Denis  R Elo,  MD 

Bryan  G Baer,  MD 

Richard  L Brundige,  MD 

F Aubrey  Copeland,  MD 

Edward  C Elsey  Jr,  MD 

Claude  D Baker  MD 

J Richard  Brusenhan,  MD 

M Larry  Copeland,  DO 

William  E Emeis,  MD 

A | Balkins  jr,  MD 

R J Brusenhan  MD 

Donald  E Cornforth  MD 

Leon  L Evans,  MD 

J Fred  Barbero,  MD 

Richard  Wm  D Bryan,  MD 

Thomas  K Craigmile,  MD 

William  W Ezell,  MD 

Hirsh  E Barmatz,  MD 

Deborah  K Bublitz  MD 

Lester  M Cramer,  MD 

Thomas  W Fawell,  MD 

Max  D Bartlett,  MD 

John  V Buglewicz,  MD 

James  W Crawford,  MD 

Fred  M Feinsod,  MD 

Thomas  R Bates,  MD 

lan-Anh  S Bui,  MD 

Lewis  A Crawford,  MD 

Donald  P Ferrell,  MD 

Dennis  I Battock,  MD 

Jack  S Burks,  MD 

Irby  E Cregger,  MD 

Kyle  M Fink,  MD 

Charles  H Bedard,  MD 

Harrison  G Butler  III,  MD 

Jerry  R Crews,  MD 

David  T Fitzgerald,  MD 

Alan  E Benson,  MD 

Bernard  E Campbell,  MD 

Michael  M Crissey,  MD 

Edward  M Fitzgerald,  MD 

Kevin  R Berg,  MD 

Peter  G Canaday,  MD 

John  P Cullen,  MD 

Elaine  V Foe,  MD 

Barry  P Berlin,  MD 

Roy  E Carlson,  MD 

William  B Cutts,  MD 

Glenn  T Foust  III,  MD 

j Tashof  Bernton,  MD 

Craig  K Carris,  MD 

Ghodsi  Daneshbod-Skibba,  MD 

G T Jim  Foust  Sr,  MD 

William  R Berry,  MD 

Cory  D Carroll,  MD 

James  J Delaney  Jr,  MD 

James  B Fowler,  MD 

Rodger  D Bildstein,  MD 

Robert  K Carver,  MD 

Robert  S Derkash,  MD 

Lisa  A Fox,  MD 

Janice  L Birney  MD 

Kenneth  J Cavanaugh  MD 

Kim  K Dernovsek,  MD 

James  C Freudenburg,  MD 

Mary  E Bissell,  MD 

Leonard  A Cedars,  MD 

Larry  M Dewell,  MD 

C Keith  Fujisaki,  MD 

David  S Blank,  MD 

Jerry  A Chase,  MD 

Theodore  C Dickinson,  MD 

W Ben  Galloway,  MD 

Stephen  F Bodman,  MD 

Mark  E Chittum,  MD 

Pasquale  A Dilorenzo,  MD 

Steven  M Gardner,  MD 

Robert  M Bogin  MD 

David  G Clark,  MD 

Michael  P Dohm,  MD 

William  F Garrett  Jr,  MD 

Colorado  Medicine  for  April,  1993 


143 


Donald  P Gazibara,  MD 
Nancy  J Germer,  MD 
Elizabeth  J Gillespie,  MD 
Bruce  T Gilmore,  MD 
Alan  S Glann,  MD 
Kenneth  P Glassman,  MD 
Thomas  M Golbert,  MD 
Monte  E Golditch,  MD 
L Barton  Goldman,  MD 
Stephen  A Goldstein,  MD 
Warren  D Goldstein,  MD 
Ray  L Gottesfeld,  MD 
Lee  B Grant  Jr,  MD 
Mark  D Guadagnoli,  MD 
Myles  S Guber,  MD 
Stanley  R Gunstream,  MD 
William  D Gurley,  MD 
Reginald  Guy,  MD 
Eric  K Hammerberg,  MD 
Richard  Hammond,  MD 
Philip  D Hanna,  MD 
Robert  S Hanna,  MD 
I R Hanson  MD 
Martin  R Harrison,  MD 
James  F Hartman,  MD 
Denzel  F Hartshorn,  MD 
John  S Harvey  Jr,  MD 
Joy  L Hawkins,  MD 
Thomas  A Haygood,  MD 
John  Hedberg,  MD 
Stephen  M Heinz,  MD 
Stephen  R Henderson,  MD 
James  R Herman  PhD 
|an  S Hildebrand,  MD 
Mark  F Hoffmann,  MD 
Rudolf  A Hofmann,  MD 
Paul  S Holley,  MD 
Douglas  L Holmes,  MD 
Stephen  W Holst,  MD 
Timothy  R Hopf,  MD 
K Mason  Howard  Jr,  MD 
Clifford  S Howe,  MD 
William  W Howland,  MD 
Paul  G Hurst  MD 
Edwin  G Hyde,  MD 
Richard  J Imber,  MD 
William  E lackson,  MD 
Philip  S Johnston,  MD 
David  W Jones,  MD 
Paul  B Jones,  MD 
Steven  O Kading,  MD 
William  R Kammerer,  MD 
Lawrence  I Karsh,  MD 
Stuart  S Kassan,  MD 
Bruce  A Katuna,  MD 
Helen  M Kechriotis,  MD 
Dean  F Kehmeier,  MD 
Ralph  L Kelley,  MD 
John  E Kemp,  MD 
L James  Kennedy  Jr,  MD 
Spencer  M King,  MD 
Daniel  L Kirby,  MD 
David  M Knize,  MD 
Gerard  G Koehn,  MD 
Harmut  W Koelsch,  MD 
Jerald  W Koepke,  MD 
Bruce  H Kolberg  MD 
Ronald  E Kramer  MD 
Robert  L Kruse,  MD 
Jeffrey  T Kulp,  MD 
David  A Labosky  MD 


Robert  J Lapidus  MD 
James  M Larkin,  MD 
Theodore  W Larremore,  MD 
Wallace  K Larson,  MD 
David  A Lavrinets,  MD 
Jay  D Law,  MD 
Richard  A Lawrence,  MD 
Donna  W Layden,  MD 
Kelly  M Lennon,  MD 
John  A Leon,  MD 
Peter  W Levitt,  MD 
Frederick  A Lewis  Jr,  MD 
Cinda  A Liggon,  MD 
Kevin  V Lindell,  MD 
Timothy  C Lindquist,  MD 
James  R Lingle,  MD 
David  B Link,  MD 
William  E Lloyd,  MD 
Jonathan  G Lord,  DO 
Kenneth  R Lovell,  MD 
Steven  J Luebbert,  MD 
Donald  C Luebke,  MD 
John  C Lundgren,  MD 
Richard  G Luzietti,  MD 
William  M MacPhee,  MD 
Archie  E Magee,  MD 
Bronwen  i Magraw,  MD 
Sandra  L Maloney 
Mickey  J Mandel,  MD 
William  J Mangione,  MD 
Cynthia  L Martin,  MD 
David  C Martz,  MD 
David  S Matthews,  MD 
Lawrence  E Maurer,  MD 
Douglas  G McCallum,  MD 
Robert  D McCartney,  MD 
David  W McCarty  IV,  DO 
John  R McCauley,  MD 
Edward  L McCleary,  MD 
Douglas  M McFarland,  MD 
John  H McVicker,  MD 
Stephen  R Meacham,  MD 
James  K Medelman,  MD 
David  E Melville,  MD 
Madeleine  C Meyer,  MD 
Joyce  E Michael,  DO 
Denise  M Miller,  MD 
Gatewood  C Milligan,  MD 
Orderia  F Mitchell,  MD 
Barry  L Molk,  MD 
Herbert  S Mooney  Jr,  MD 
Patrick  G Moran,  MD 
Thomas  G Mordick  II,  MD 
Alethia  E Morgan,  MD 
George  T Morgan,  MD 
George  T Morgan,  MD 
C Eugene  Mossberg,  MD 
Alan  R Murphy,  MD 
Jeffrey  M Nakano,  MD 
J Nicholas  Napoli,  MD 
Herbert  M Nason,  MD 
Robert  A Nathan,  MD 
Ruth  B Nauts,  MD 
Alexander  B Neel,  MD 
Theodore  C Ning  Jr,  MD 
Martin  E Nowick,  MD 
Airell  L Nygaard,  MD 
Martin  E O'Brien,  MD 
Richard  S O'Donnell,  MD 
John  J O'Neill,  MD 
Frederick  C Oakes  Jr,  MD 
Ronald  C Ochsner,  MD 


Tania  Orzynski,  MD 
David  M Oster  MD 
J Cuthbert  Owens,  MD 
M Ray  Painter  Jr,  MD 
Lynn  Parry,  MD 
Sally  A Parsons,  MD 
Jacob  F Patterson,  MD 
Frank  A Perreten,  MD 
Walter  W Perrott  III,  MD 
Mark  Petrun,  MD 
Lyle  M Pfeifer,  MD 
Eugene  W Pflurn,  MD 
David  S Pfoff,  MD 
Dwight  S Phelps,  MD 
Thomas  M Pickard,  MD 
Gerald  J Pise,  MD 
David  A Podlecki,  MD 
Claude  S Poliakoff,  MD 
Bernard  J Powers,  MD 
Peter  Press,  MD 
Jerry  G Price,  MD 
J Christopher  Pruitt  MD 
James  L Quinby,  MD 
Richert  E Quinn  Jr,  MD 
Alan  M Rapaport,  MD 
Dennis  C Raphael,  MD 
Perry  L Rashleigh,  MD 
Karen  N Ratner,  MD 
Frank  R Rauzi,  MD 
James  B Rector,  MD 
Gerald  D Reilly,  MD 
William  B Repert,  MD 
John  C Riccio,  MD 
Anthony  Richards,  MD 
David  L Richardson,  MD 
Kenneth  R Richardson  MD 
Brian  A Ridge  MD 
William  A Roberts,  MD 
Lothar  K Roller,  MD 
Molly  E Romary,  MD 
Alan  L Rosenberg,  MD 
Ronald  O Royce,  DO 
Samuel  M Rubinson,  MD 
Mark  W Rubright,  MD 
Gerald  R Rupp  MD 
Jarvis  D Ryals,  MD 
John  S Sabel,  MD 
Julio  C Salimbeni  MD 
Noel  E Sankey,  MD 
John  A Santoro  Jr,  MD 
James  A Sbarbaro,  MD 
David  J Scanavino,  MD 
Larry  A Schafer,  MD 
Robin  L Schaten,  MD 
Philip  A Schechter,  MD 
Janet  E Schemmel,  MD 
John  J Schmidt,  MD 
Dieter  W Schneider,  MD 
Michael  J Schoo,  MD 
Harvey  A Schuchman,  MD 
Dilworth  P Sellers,  MD 
John  C Seiner,  MD 
William  R Seybold,  MD 
Ronald  D Shippert,  MD 
Leroy  j Sides,  MD 
Patrick  A Siliix,  DO 
John  C Sinclair,  MD 
Albert  O Singleton  III,  MD 
Daniel  L Smith,  MD 
Jerome  I Smith,  MD 
John  P Smith,  MD 


Myron  C Smith,  MD 
Wallace  A Sneddon,  MD 
Charles  E Snyder,  MD 
Mark  D Solano  MD 
Duane  R Spaulding,  MD 
David  W Steedle,  MD 
Richard  H Steinmier  MD 
Stephen  K Stewart,  MD 
Richard  H Stienmier,  MD 
Del  Stigler,  MD 
Norma  J Stiglich,  MD 
Melvin  R Stjernholm,  MD 
William  W Storms,  MD 
Helen  M Story,  MD 
Meiford  L Strand,  MD 
Roy  C Stringfellow,  MD 
Patrick  J Sullivan,  MD 
Barry  Sundland  MD 
Marc  H Tanenbaum,  MD 
Anschel  Tarlie,  MD 
Robert  M Tate,  MD 
Ronald  E Tegtmeier,  MD 
Daniel  T Teitelbaum  MD 
D B Thatcher  MD 
John  P Thomas,  MD 
J Robert  Thompson  Jr,  MD 
Robert  E Tonsing,  MD 
Leigh  Truitt,  MD 
Donn  M Turner,  MD 
Lisa  A Turner,  MD 
George  O Tutt  Jr,  MD 
Joseph  A Tyburczy  Jr,  MD 
James  G Urban,  MD 
Frank  W.  VanDeWater,  MD 
Charles  J VanHook,  MD 
Kurt  W VonRueden,  MD 
Kay  E Wagner,  MD 
John  A Waller,  MD 
James  S Warson,  MD 
Steve  W Waxman,  MD 
Peter  Weiss,  MD 
Stanley  S Weiss  MD 
B Lynn  West,  MD 
Harry  L Wherry  MD 
Patrick  L Wherry,  MD 
Eric  A White,  MD 
Paul  D Wiesner  MD 
Eugene  O Wiggs,  MD 
William  J Williams,  MD 
Murray  S Willis,  MD 
Robert  E Winans,  DO 
Denis  J Winder,  MD 
Diane  L Wing,  DO 
Timothy  C Wirt,  MD 
Michael  W Woods,  MD 
M Robert  Yakely,  MD 
Ann  K Yanagi,  MD 
S Steve  Yasuzawa,  MD 
Harold  A Yocum,  MD 
Byron  A Yost,  MD 
John  F Yost,  MD 
James  A Zimmer,  DO 
Delvin  L Zopf,  MD 


144 


Colorado  Medicine  for  April,  1993 


The  Medical  Student  Component, 

chaired  by  Anthony  Nagorka,  met 
February  3,  1 993. 

Maura  Lofaro  informed  the 
group  of  a creative  writing  contest  to 
be  held  late  Winter/early  Spring,  for 
medical  students.  Rules  of  the 
contest  will  be  published  in  Colo- 
rado Medicine.  Prizes  of  $200,  $ 1 00, 
and  $50  will  be  awarded  to  the  top 
three  winners,  to  be  determined  by 
the  CMS  board  of  directors.  The 
money  will  come  from  the  medical 
student  component  funds,  until 
approval  for  prize  money  coming 
from  CMS  is  obtained. 

At  the  Educational  Research 
Foundation  April  meeting,  a scholar- 
ship which  would  be  awarded  to  a 
student  member  of  the  CMS  deemed 
as  having  contributed  the  most  to 
professional  medicine  during  the 
preceding  year,  will  be  discussed. 
Maura  will  attend. 

A "Leadership  Award"  will  also 
be  discussed  at  the  next  BOD 
meeting.  If  approved,  this  award 
would  be  for  $500,  and  a plaque. 
Maura  will  attend  the  BOD  meeting 
during  which  this  will  be  discussed, 
and  will  inform  the  membership  of 
when  and  how  the  applications  for 
this  scholarship  may  be  made,  if 
approved. 

Scut-day:  The  CMS-MSC  and 
AOA  will  be  sponsoring  a Scut-day 
this  Spring,  for  interested  Sopho- 
mores. We  are  currently  looking  for 
equipment  donations  from  the 
school,  neighboring  hospitals,  and 
private  physicians.  Those  interested 
in  helping,  please  cal!  Maura  Lofaro, 
at  377-9851 . Also,  CMS  members 
will  be  needed  to  help  on  the  day 
itself,  so  if  you  receive  a call  from 


the  group  working  on  this  event, 
please  try  to  give  generously  of  your 
precious  time  and  copious  talent! 

A discussion  for  the  benefit  of 
the  1st/2d  years,  given  by  the  3d/4,h 
years,  is  being  organized  for  the  May 
6th  Lunchbox.  Interested  upperclass- 
men, please  call  Paul  Bonnaci  (388- 
3852). 

The  first  phase  of  the  CMS 
mentor  program  is  being  worked  on 
by  Maura  Lofaro.  She  will  match  up 
interested  students  with  physicians  in 
the  community  who  are  interested  in 
mentoring  students.  This  should  be 
done  by  the  end  of  this  Spring. 

Theresa  Scholz  and  Paul  Bon- 
naci will  be  following  up  with  a 
second  phase  of  the  mentor  program, 
which  will  make  available  lists  of 
physicians  interested  in  mentoring, 
by  specialty,  to  student  CMS  mem- 
bers who  are  interested  in  finding 
mentors,  and  'vice  versa'.  This 
service  (up-to-date  listing)  will  be 
available  to  all  members  of  the  CMS- 
Medical  Student  Component  by  Fall, 

1 993,  and  should  help  to  alleviate 
the  dearth  of  personal  guidance 
many  students  currently  experience 
during  their  four  years  of  school. 

Mr.  Mark  Flemming,  a New  York 
Life  financial  advisor,  presented  a 
disability  program  available  to  third 
and  fourth  year  students.  Most 
insurance  plans  will  not  provide 
disability  insurance  to  people 
without  an  income,  including 
students.  The  plan  can  provide 
income  up  to  $1  500/mo  in  the  case 
of  disability,  for  <$40/mo.  Call  Mark 
at  861  -821  5 for  more  information. 
(FHe  is  the  husband-to-be  of  one  of 
our  fourth-year  classmates,  and  has 
already  provided  this  type  of  insur- 


A monthly  report  of 
current  and  on-going 
activities  of  the  Councils , 
Committees  and  Sections 
of  the  Colorado  Medical 
Society.  None  of  the 
information  herein  is 
meant  to  indicate  a policy 
or  position  statement  of 
the  Colorado  Medical 
Society.  This  report  is 
designed  only  to  inform 
CMS  members  of  their 
organization's  activities 
and  study  projects  at  the 
Council,  Committee  or 
Section  level. 


continued  on  following  page... 


Colorado  Medicine  for  April,  1993 


145 


A resolution  to  have  a 
student  as  a voting 
member  of  the  Board  of 
directors  has  been 
submitted  for 
consideration  at  the  CMS 
Interim  Meeting  in  April. 


ance  to  many  fourth  year  students.) 

A resolution  to  have  a student  as 
a voting  member  of  the  Board  of 
directors  has  been  submitted  for 
consideration  at  the  CMS  Interim 
Meeting  in  April.  The  next  student 
Board  member  will  be  elected  in  the 
general  elections  this  Spring. 

Tom  Schossau  informed  the 
membership  that  Dean  Nelson 
approved  the  fun  run  to  benefit  Stout 
Street  Clinic.  The  run  will  be  on 
April  1 7.  Given  the  beneficiary  of  the 
run,  the  CMS-MSC  has  agreed  to 
support  the  run  with  people-power. 
Tom  suggests  that  we  staff  a water 
table,  and  possibly  a CMS  informa- 
tion booth  at  the  finish-line  of  the 
race.  Anyone  interested  in  helping  as 
a CMS  member,  please  call  Theresa 
Scholz  at  321  -8860,  or  Tom  Schos- 
sau at  355-0946. 

The  by-laws  were  modified  by 
those  present.  This  allows  Society 
elections  to  be  moved  from  the  Fall 
to  the  Spring,  which  is  thought  to  be 
best  for  continuity  of  Society  work 
throughout  the  Summer. 

The  next  general  MSC  meeting 
will  be  held  on  Wednesday,  April 
28,  in  the  Biomedical  Building,  room 
823,  at  6:30  pm.  Dinner  will  again 
be  provided  by  CMS.  RSVP  to 
Theresa  Scholz,  321-8860  if  you 
can. 

The  Physician/Patient  Advisory 
Council  has  been  monitoring  the 
Medicaid  program  and  associated 
legislative  activities.  The  Department 
of  Social  Services  (DSS)  has  attended 
various  Council  meetings  to  address 
Medicaid  issues  and  seek  opinions 
from  the  Colorado  Medical  Society 
(CMS).  Activities  regarding  Medicaid 
include:  1)  the  Council  voted  to 


participate  in  a Primary  Care  Physi- 
cian Advisory  Committee  once  it  is 
created  by  DSS,  and  2)  the  Council 
will  assist  DSS  in  the  development  of 
an  educational  video  to  teach 
Medicaid  recipients  appropriate 
utilization  of  their  health  care 
coverage  under  Medicaid. 

Resolution  78-P  regarding 
managed  care  has  been  the  main 
agenda  item  at  recent  Council 
meetings.  Due  to  the  multitude  of 
issues  contained  in  this  resolution, 
the  Council  will  continue  to  work  on 
it  in  the  upcoming  months.  The 
Council  has  scheduled  a meeting  in 
March  of  1 993  to  meet  with  repre- 
sentatives of  various  HMOs  to  see  if 
some  or  all  of  the  problems  can  be 
resolved.  This  meeting  is  an  attempt 
to  create  open  communication, 
determine  acceptable  solutions,  and 
possibly  eliminate  the  need  for 
extensive  legislation. 

The  Council  successfully  con- 
vinced the  Sunrise/Sunset  Committee 
to  introduce  legislation  regulating 
private  utilization  review  firms  (SB- 
93-021).  The  Council  feels  that  the 
legislation  is  a step  in  the  right 
direction.  As  of  this  writing,  SB-93- 
021  is  still  alive  and  making  its  way 
through  the  legislature. 

The  Workers'  Compensation 
Advisory  Committee  continues  to 
closely  monitor  the  Workers'  Com- 
pensation system  and  the  Division  of 
Workers'  Compensation.  The 
Committee  has  been  active  on 
various  task  forces  created  by  the 
Division.  Some  of  the  issues  being 
addressed  by  the  Committee  are:  1 ) 
timely  payment  by  insurance  compa- 
nies, 2)  arbitrary  down  coding  by 
insurance  companies,  3)  providing 


146 


Colorado  Medicine  for  April,  1993 


testimony  at  hearings  regarding 
various  rules  and  regulations,  4) 
discussion  concerning  Workers' 
Compensation  within  health  care 
reform,  5)  ongoing  individual 
member  concerns,  and  6)  issues 
associated  with  auto  no-fault  (per- 
sonal injury  protection)  including  use 
of  the  Workers'  Compensation  fee 
schedule  as  a basis  for  reimburse- 
ment. 

The  Medicare  Advisory  Committee 

continues  to  address  Medicare 
problems  on  a monthly  basis  with 
Blue  Cross  and  Blue  Shield  of 
Colorado,  the  local  Medicare 
Carrier.  Confusion  still  exists  both 
with  the  Carrier  and  Colorado 
physicians  regarding  the  ever- 
changing  Medicare  rules  and 
regulations.  Every  meeting  deals  with 
specific  issues/problems  generated 
by  physician  letters  and  phone  calls 
that  need  to  be  clarified. 

A major  issue  the  Committee  is 
addressing  is  the  reinstatement  of 
Medicare  payments  for  EKGs  and  the 
elimination  of  the  new  physician 
reduction.  The  Committee  is  aware 
of  federal  legislation  introduced  this 
session  dealing  with  these  issues. 

The  Committee  will  review  the 
legislation  and  will  then  provide 
recommendations  to  the  Council  on 
Legislation.  If  the  legislation  mirrors 
CMS  policy,  the  Committee  will  be 
drafting  letters  to  the  Colorado 
Congressional  delegation  calling  for 
their  support  of  the  legislation.  At 
that  point  it  may  also  be  appropriate 
for  CMS  to  call  on  Colorado  physi- 
cians to  write  individual  letters. 

The  next  meeting  of  the  CMS 
Education  and  Research  Foundation 
will  be  April  1 7,  4:30  p.m.,  at  the 
offices  of  W.  Gerald.  Rainer,  MD. 


The  Committee  on  Accreditation, 
chaired  by  L.  H.  Stahlgren,  MD,  will 
meet  May  6,  4:00  p.m.,  at  the  CMS 
offices. 

The  Council  on  Professional 
Education,  chaired  by  Richard  F. 
Bakemeier,  MD,  met  February  18. 

Dr.  Wm.  Carl  Bailey  outlined  the 
President-Elect's  Planning  Confer- 
ence set  for  July  1 7-1 8 at  the  Fort 
Collins  Marriott.  In  addition  to  their 
current  activities  each  Council  and 
Committee  will  be  asked  to  review 
their  accomplishments  over  the  past 
three  years,  then  look  to  the  future  to 
determine  direction  and  goals. 
Council  members  will  complete  a set 
of  questions  and  discuss  them  at  the 
next  meeting  scheduled  May  20, 

4:00  p.m.,  at  the  CMS  offices. 


For  more  information 
about  any  of  the  Councils 
or  Committees  of  CMS, 
please  call  (303)  779- 
5455  or  1-800-654-5653 
and  ask  for  the 
appropriate  staff  member. 


Donald  J.  Northey,  M.A. 

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Audiological  Consultants,  Inc. 

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Colorado  Medicine  for  April,  1993 


147 


Photo  by  Gil  Maestas,  II 


A Friendship  Bridge  from  the 
United  States  to  Vietnam 


by  Gil  Maestas,  II 


Theodore  C.  Ning  Jr.,  MD 


Physicians  from  Colorado  and 
across  the  United  States  are  giving  of 
themselves  to  improve  health  care 
half  a world  away  through  Friend- 
I ship  Bridge,  a non-profit,  humanitar- 
! ian  organization  that  is  helping  to  fill 
the  health  care  void  which  exists  in 
Vietnam.  Colorado  Medicine 
recently  had  the  opportunity  to  speak 
with  Theodore  C.  Ning  Jr.,  M.D.  an 
eighteen  year  member  of  the  Colo- 
rado Medical  Society  who  practices 
Urological  Surgery  primarily  at 
Lutheran  Hospital  in  Wheat  Ridge.  In 
addition  to  teaching  in  the  United 
States,  Dr.  Ning  has  taught  in  China, 
Korea,  Thailand  and  India. 

Friendship  Bridge  is  the  comple- 
tion of  an  idea  that  started  twenty- 
two  years  ago  while  Dr.  Ning  served 
the  United  States  in  Vietnam  with  the 
1 01  st  Airborne  Division.  During  his 
tour  the  young  Theodore  Ning 
observed  many  large  humanitarian 
organizations  working  to  help  the 
same  population,  but  not  working 
together  or  communicating  to 
improve  the  existing  health  care 
system  as  a whole. 

After  returning  to  the  United 
States,  completing  medical  school 
and  starting  a family,  Dr.  Ning 
became  Medical  Director  and 
President  of  the  International  Adop- 
tion Association  in  Colorado.  Dr. 
Ning  and  his  wife  Constance  are  the 
parents  of  six  children,  Three 
biological,  two  from  Korea  and  a 
third  from  Vietnam.  This  gave  them 
the  opportunity  to  do  a fair  amount 
of  travel.  In  1988,  while  traveling  in 
Vietnam  with  the  Adoption  Associa- 
tion, Mrs.  Ning,  now  President  of 
Friendship  Bridge,  observed  the 
impoverished  conditions  of  the 


women's  and  children's  hospitals 
and  stated,  "This  is  a situation  that 
we  can  do  something  about".  Mrs. 
Ning  made  a deal  with  American 
diplomats  who  were  not  really  aware 
how  much  suffering  was  taking 
place,  to  go  back  to  the  United 
States,  raise  funds  to  purchase 
antibiotics  and  then  come  back  and 
try  to  help.  They  gave  approval.  This 
is  how  Friendship  Bridge  was 
conceived.  Dr.  Ning  obtained 
permission  from  the  United  Nations 
to  bring  a small  group  of  Americans 
concerned  with  health  care  and 
humanitarian  efforts  into  the  country. 
During  1988-89  The  Nings  came 
into  contact  with  other  U.S.  citizens 
who  were  traveling  to  Vietnam  for 
various  personal  reasons.  They  all 
had  one  thing  in  common;  a desire 
to  make  a bad  situation  better. 
"Vietnam  today  is  one  of  the  poorest 
and  saddest  countries  in  the  world, 
and  its  health  care  facilities  are 
barely  functioning.  They  lack 
everything,"  states  Dr.  Ning.  In  April 
of  1990,  Friendship  Bridge  incorpo- 
rated. Originally,  the  group  was 
comprised  of  business  people  and  a 
few  physicians.  Today  there  are  over 
100  Colorado  physicians  actively 
involved.  As  stated  by  Dr.  Ning, 
"There  are  actually  physicians  that 
are  coming  out  of  retirement  to 
become  involved  and  lend  a helping 
hand  to  Friendship  Bridge".  In  May, 
CMS  member  Dr.  Kyle  Fink  will  lead 
a group  of  seven  physicians  from  P/ 
SL  into  Vietnam. 

As  stated  by  Dr.  Ning,  "Vietnam 
has  left  a permanent  mark  on  a lot  of 
people,  people  who  had  brothers 
and  sisters  who  served  there,  or  had 
children  who  served  there,  or  had 


148 


Colorado  Medicine  for  April,  1993 


heard  of  this  thing  that  you  never 
talked  about,  for  example,  'Tell  me 
dad,  who  won  the  Vietnam  war?' 
There  has  been  a tremendous 
shadow  on  the  American  conscious- 
ness. Many  people  just  wanted  to  go 
an  see  what  an  enemy  looks  like. 
There  are  a lot  of  mixed  interests  and 
reasons  why  people  want  to  go." 

Because  of  the  desperate  condi- 
tions in  its  health  care  facilities  and 
the  virtual  isolation  of  its  physicians, 
many  of  Vietnam's  health  care 
professionals  fled.  As  stated  by  Dr. 
Ning,  "Some  of  these  men  and 
women  stayed  in  Vietnam  not  out  of 
support  for  the  government  but 
because  they  experienced  the 
hopeless  restrictions  being  imposed 
on  their  fellow  citizens  and  they 
knew  if  they  left  there  would  be  no 
one  to  take  their  places  and  profes- 
sional health  care  would  all  but 
disappear  ...These  are  the  men  and 
women  with  whom  we  work,  trying 
to  build  on  their  initial  training  and 
bringing  them  current  as  well  as 
helping  to  supply  them  with  medica- 
tions and  equipment  for  their 
hospitals."  In  a conversation  be- 
tween New  York  publicist,  Joseph 
Policano  and  Dr.  Ning,  the  doctor 
stated  that  "our  greatest  accomplish- 
ment is  bringing  hope  to  the  health 
care  professionals  who  stayed  in 
Vietnam.  We  show  them  they  are  not 
isolated  and  that  there  is  support  for 
them  in  the  United  States  and  our 
presence  in  Vietnam  is  part  of  the 
brotherhood  and  sisterhood  of 
medicine."  In  Dr.  Ning's  interview 
with  Colorado  Medicine  he  ex- 
pressed that  physicians  are  a vital 
component  to  the  program,  but  it's 
really  the  nurses  that  have  become 


the  "work 
horses"  of  the 
project.  They 
are  the  ones 
who  have  to 
know  how  to 
operate  and 
maintain 
equipment, 
assist  in 
procedures 
and  be  aware 
of  all  the 
changes 
taking  place. 

"The  nurses 
are  the  ones 
that  carry  the 
day,"  said  Dr. 

Ning. 

Dr.  Ning  summed  up  the  mission 
of  Friendship  Bridge  in  a recent  letter 
to  the  Editor  of  The  Western  Journal 
of  Medicine. 

Friendship  Bridge  works 
with  physicians  and  hospitals  in 
Vietnam  (not  with  the  Vietnam- 
ese government)  in  these  ways: 
we  send  teams  of  American  vol- 
unteer physicians  and  other 
health  care  professionals  there 
for  two- week  periods  to  lecture 
and  train  their  Vietnamese  coun- 
terparts: we  send  new  and  used 
medical  equipment  and  supplies 
to  hospitals  and  clinics;  and  we 
seek  sponsors  who  can  under- 
write visits  to  the  United  States 
by  Vietnamese  health  care  work- 
ers for  up  to  three  months  of 
training. 

Generally,  our  health  care 
teams  do  not  practice  clinical 
medicine  because  we  would 
rather  train  and  teach  Vietnam- 


David  Silver ; MD  looks 
after  a young  patient 


Colorado  Medicine  for  April,  1993 


149 


General  Surgeon  and  CMS 
member  J.  Stewart 
Williams > MD  pauses  near 
a sign  announcing  his 
arrival. 


esephysicianstodo 
the  necessary  pro- 
cedures. Here  are 
some  of  the  things 
we  have  accom- 
plished in  the  few 
years  that  Friend- 
ship Bridge  has 
been  in  existence: 

* Twenty  separate 
delegations  have 
traveled  to  Vietnam 
to  assess  needs  and 
havealso  hand-car- 
ried requested  med- 
ical supplies. 

* Since  July  1 990,  over  1 20  tons 
of  medical  equipment,  supplies, 
and  books  have  been  shipped  to 
Vietnam  to  be  distributed  to  six 
teaching  hospitals  in  Saigon  and 
Hanoi. 

* We  have  sponsored  13  distin- 
guished Vietnamese  physicians, 
nu  rses,  and  dentists  for  advanced 
study  in  the  Denver  area. 

* We  have  created  teaching 
projects  in  nursing  education, 
English  training  for  Vietnamese 
physicians  and  nurses,  cardiol- 
ogy, urology,  orthopedics,  res- 
piratory therapy,  physical 
therapy,  critical  care  anesthe- 
sia, and  dentistry. 

In  Dr.  Ning's  interview  with  Colo- 
rado Medicine,  he  expressed  that  most 
people  become  physicians  out  of  a 
desire  to  care  for  and  help  other  human 
beings.  He  feels  that  in  today's  world  of 
corporate  medicine,  many  doctors  feel 
that  they  have  lost  sight  of  what  they 
originally  set  out  to  do.  By  sharing 
knowledge  and  truly  helping  others  to 
help  themselves,  "that  part  of  their  soul 
that  was  lost,  can  be  found". 


Friendship  Bridge  would  like  to 
hear  from  physicians  and  other 
health  care  professionals  who  wish 
to  volunteer  with  them  in  some 
capacity.  The  need  is  so  great  in 
Vietnam  that  every  discipline  can 
find  a role  there.  All  volunteers  pay 
their  own  expenses,  which  are 
usually  tax-deductible.  Friendship 
Bridge  will  make  all  the  necessary 
arrangements,  from  forming  the 
American  teams  (usually  three  or 
four  professionals),  to  locating  a 
specific  hospital  where  you  will 
teach,  to  arranging  for  your  visa  and 
reserving  hotel  rooms.  Spouses  may 
accompany  the  volunteers  and  often 
serve  as  well,  giving  English  lessons 
to  Vietnamese  citizens  or  using  other 
skills  they  may  have.  Costs  are 
approximately  $2,500  to  $3,000  per 
person,  sums  that  are  paid  directly  to 
airlines  and  hotels.  Friendship  Bridge 
does  not  charge  a fee  for  its  services, 
though  contributions — tax  deduct- 
ible as  allowed  by  law — are,  of 
course,  always  appreciated.  For 
additional  information  you  can 
contact  Friendship  Bridge  at,  33424 
Deep  Forest  Rd,  Evergreen,  CO 
80439;  or  telephone  (303)  421-1  203; 
FAX  (303)  423-7329. 


150 


Colorado  Medicine  for  April,  1993 


by  Mary  Jo  Jacobs,  M.D. 


All  of  us  recently  received  an 
alert  and  a questionnaire  from  CMS 
soliciting  our  opinion  on  legislation 
regarding  an  exception  to  the  general 
prohibition  of  the  Corporate  Practice 
of  Medicine.  Although  there  may  be 
reasonable  concern  regarding 
whether  or  not  the  questionnaire  was 
unbiased  in  its  wording  and  presen- 
tation, the  results  were  overwhelm- 
ingly in  opposition  to  hospitals  being 
able  to  employ  physicians. 

As  stated  in  our  "Alert",  the 
doctrine  is  intended  to  prevent 
commercial  and  economic  pressures 
from  influencing  diagnosis,  treat- 
ment, and  care  of  patients  by 
physicians.  An  additional  goal  might 
be  stated  "to  protect  the  public  from 
those  who  are  not  properly  qualified 
or  are  incompetent  to  practice 
medicine".  The  doctrine  was  in- 
tended to  prevent  commercialism  in 
medicine  and  to  avoid  divided 
physician  loyalty  between  the  patient 
and  a parent  corporation. 

I would  ask  you  to  consider  the 
evidence  that  the  supposed  protec- 
tion offered  by  the  prohibition  of  the 
Corporate  Practice  of  Medicine  no 
longer  reflects  the  facts  and  as 
physicians  we  would  be  better 
served  by  helping  update  this 
antiquated  law  rather  than  declaring 
our  total  opposition. 

In  1 957,  Bing  v.  Thunig  was 
decided  in  the  New  York  Court  of 
Appeals,  declaring  the  "conception 
that  the  hospital  does  not  undertake 
to  treat  the  patient...  no  longer 
reflects  the  facts".1  Darling  v.  Char- 
leston Community  Hospital2  further 
extended  the  hospitals'  responsibility 
in  regard  to  patient  safety  by  requir- 
ing a chain  of  command  and  review- 
ing patient  care.  The  hospitals' 
broader  authority  now  includes 


Guest 


requirements  to  assure  a competent 
medical  staff,  to  periodically  access 
the  National  Data  Bank  on  Physi- 
cians, and  to  guarantee  informed 
consent  prior  to  procedure.  More 
recent  regulations  have  also  made  it 
necessary  for  hospitals  to  request 
organ  donations,  and  to  inquire  and 
educate  Medicare  patients  regarding 
end-of-lite  decision-making,  living 
wills  and  durable  powers  of  attorney. 

Perhaps  the  real  turning  point  in 
public  policy  came  with  the  enact- 
ment of  the  HMO  legislation  in 
1973.  "The  HMO  legislation  and 
subsequent  proliferation  and  accep- 
tance of  HMOs  evidence  the  modern 
disutility  of  the  corporate  practice 
prohibition.  The  legislation  itself  is  a 
sweeping  federal  health  care  policy 
statement  in  favor  of  a corporate- 
based,  competitive  health  market. 
The  legislation  eschews  a medical 
economy  dominated  by  indepen- 
dent, fee-for-service  practitioners".3 

These  are  but  a few  examples  of 
the  many  ways  in  which  the  relation- 
ship of  the  physician  and  the  hospital 
have  changed.  Our  individual 
relationships  with  HMOs  and  PPOs 
have  already  violated  the  intent  of 
corporate  practice  prohibition.  Our 
CMS  Physician/Patient  Advocacy 
Committee  gets  frequent  letters  from 
physicians  decrying  the  restrictions 
placed  on  their  diagnosis  and 
treatment  decisions  although  they 
personally  signed  contracts  allowing 
the  action  being  taken.  The  protec- 
tion previously  afforded  us  by  law 
has  been  abdicated  by  our  own 
actions  of  surrendering  to  the 
economic  pressures  of  competition 
and  signing  away  those  rights  in 
contract. 


Therefore,  it  is  redundant  and 
unfair  of  us  to  position  ourselves  in 
opposition  to  legitimate  attempts  by 
rural  hospitals  to  become  competi- 
tive in  the  labor  market  when  we 
have  sanctioned  such  competition  in 
urban  areas.  Rural  hospitals  have  the 
same  corporate  responsibilities  as 
previously  described,  and  we  would 
do  better  to  forge  working  partner- 
ships with  our  hospitals  with  whom 
we  still  have  the  common  commu- 
nity goal  of  good  care  of  our  pa- 
tients. Other  corporate  arrangements 
with  nationally  positioned,  for-profit 
companies  may  be  more  suspect  of 
profiteering  than  good  patient  care, 
and  it  continues  to  be  our  ethical 
obligation  as  well  as  our  area  of 
expertise  to  demand  quality  of  care 
protections  for  our  patients  in  any 
commercial  relationships  we  estab- 
lish. 

Within  the  framework  of  our 
government  we  have  a good  oppor- 
tunity to  act  prospectively,  rather 
than  always  retrospectively  voicing 
our  disapproval  and  objections.  The 
tension  between  the  medical  profes- 
sion's control  of  medical  decision- 
making and  cost  control  decisions 
placed  in  the  hands  of  consumers 
will  be  manageable  only  when  we 
take  our  heads  out  of  the  sand  and 
participate  more  actively  in  a truly 
democratic  health  care  system. 

References 

1 . Bine  v.  Thunig.  2 N.Y.  2d  656,666,  1 43 
N.E.  8 2d  3 (1957) 

2.  Darling  v.  Charleston  Community 
Memorial  Hospital,  33  1 1 1 , 2d  326,  21  1 
N.E.  2d  253  (1965) 

3.  Chase,  jeffrey  F.  The  Corporate  Practice  of 
Medicine  Doctrine:  An  Anachronism  in 
the  Modern  Health  Care  Industry, 
Vanderbilt  Law  Review,  March,  1987,  p. 
488 


Colorado  Medicine  for  April,  1993 


151 


Emergency  consultation  for 
HMO-hospital  patients 


Mark  W.  Elliott,  MD 


The  following  HMOs  in  Colo- 
rado provide  24-hour  telephone 
access: 

Comprecare — 695-6685 
Kaiser  Permanente— 831-6683 
Southern  Colorado  Health 
Plan— 545-6274 


Certain  questions  prevail  concerning 
emergency  consultation  for  Health 
Maintenance  Organization  (HMO) 
patients  in  the  hospital  setting. 

This  article  has  been  prepared 
through  the  efforts  of  the  Colorado 
Medical  Society  (CMS),  the  Colorado 
Chapter  of  the  American  College  of 
Emergency  Physicians  (CO-ACEP), 
the  Colorado  HMO  Association  and 
the  Colorado  Hospital  Association 
(CHA)  to  address  questions  and 
perceptions  regarding  emergency 
consultation  for  the  HMO  patient. 

Definition  of  Emergency 
Consultation 

Understanding  and  defining  an 
"emergency  consultation"  appears  to 
be  a major  factor  in  resolving  certain 
HMO  patient  care  and  payment 
issues.  "Consultation"  must  first  be 
defined,  then  further  clarified  to 
reflect  "emergency". 

"Consultation"  means  the 
rendering  of  an  opinion,  advice  or 
treatment  by  a physician  at  the 
request  of  the  physician  who  has 
examined  and  assumed  responsibil- 
ity for  the  care  of  the  HMO  patient. 
Examples  include  the  Emergency 
physician  caring  for  the  patient  who 
determines  a specialist  is  needed  for 
continuing  or  definitive  care,  or  the 
attending  physician  caring  for  the 
patient  who  needs  another  phys- 
ician's expertise. 

"Emergency  Services"  means 
medically  necessary  consultation 
services  that  are  immediately 
required  because  of  unforeseen 
illness  or  injury.  Such  services  must 
be  or  must  appear  in  the  reasonable 
judgment  of  the  physician  who  has 
examined  and  assumed  responsibil- 


ity for  the  patient  to  be  needed 
immediately  to  prevent  the  death  of 
the  HMO  patient  or  serious  impair- 
ment of  the  HMO  patient's  health. 

"Emergency  Consultation"  is 
defined  as  an  emergency  service 
consisting  of  "consultation"  to 
provide  definitive  care  for  the  patient 
who  requires  emergency  services  or 
to  provide  emergency  services 
necessary  for  stabilization.  Examples 
include  the  need  for  specialty  care  in 
the  Intensive  Care  setting  or  defini- 
tive care  (i.e.,  fracture  reduction, 
emergency  surgery)  prior  to  dis- 
charge from  the  inpatient  setting  or 
emergency  department. 

Background 

COBRA  and  OBRA  legislation 
mandates  that  all  Medicare  partici- 
pating hospitals  maintain  "on-call" 
lists  of  physicians  to  provide  stabili- 
zation of  patients  presenting  to  the 
hospital  for  emergency  care.  HMO's 
maintain  their  own  lists  of  participat- 
ing physicians.  The  HMO  participat- 
ing provider  list  may  not  correlate 
with  the  hospital  "on-call"  list. 

Conflicts  arise  when  an  "on-call" 
physician  is  needed  for  care  and  s/he 
dies  not  participate  with  the  patient's 
HMO.  Simply  accessing  the  "on- 
call"  physician  will  satisfy  OBRA 
requirements.  The  "on-call"  physi- 
cian is  legally  obligated  by  OBRA  to 
care  for  the  patient  regardless  of 
HMO  contracts.  However,  both 
patients  and  "on-call"  physicians 
have  expressed  concerns  about 
emergency  consultation  services  for 
HMO  patients.  Those  issues  are 
addressed  in  the  following  para- 
graphs regarding  access  to  "emer- 
gency consultation"  and  reimburse- 
ment. 


152 


Colorado  Medicine  tor  April,  1993 


HMO  Benefits  and 
Emergency  Consultation 

Any  discussion  of  emergency 
consultation  must  occur  within  the 
context  of  the  HMO's  benefit 
schedule.  HMOs  provide  defined 
benefits  and  services  through 
participating  physicians.  HMOs  are 
obligated  to  provide  emergency 
services  through  either  participating 
or  non-participating  providers.  If  the 
consultation  services  provided  fall 
within  the  definition  of  emergency 
services,  then  the  HMO  is  obligated 
to  provide  or  pay  for  those  services 
according  to  its  contract.  If  the 
consultation  is  not  emergency 
services,  then  in  order  to  be  covered, 
the  consultation  must  be  provided 
through  participating  providers  upon 
referral  by  the  HMO  patient's 
primary  care  physician. 

Access  to  Emergency 
Consultation 

We  all  need  to  be  concerned  with 
cost  containment,  the  ways  HMOs 
address  cost  containment  is  by 
managing  access  to  care.  To  ensure 
that  care  is  provided  in  the  proper 
setting  and  when  appropriate,  HMOs 
require  that  all  HMO  members  select 
a primary  care  physician. 

With  the  exception  of  Kaiser 
members,  the  HMO  patient's 
primary  care  physician  should  be 
contacted  regarding  emergency 
consultation,  if  possible,  to  provide 
the  name  of  the  appropriate  HMO 
participating  consultant  and  to 
approve  the  need  for  such  services. 
For  emergency  consultation  for 
Kaiser  members,  call  the  Kaiser 


Permanente  24-hour  telephone 
number  listed  at  left. 

If  the  primary  care  physician  is 
unavailable  or  cannot  provide  the 
necessary  information,  then  the 
following  steps  should  be  taken: 

1 . Access  24-hour  HMO  telephone 

number,  if  available 

2.  Access  the  hospital  on-call  list. 

Reimbursement  to 
Emergency  Consultants 

An  HMO  patient  can  reasonably 
expect  that  an  "Emergency  Consulta- 
tion" within  the  above  guidelines 
will  be  a covered  benefit.  An  HMO 
participating  physician  who  provides 
an  "Emergency  Consultation"  to  an 
HMO  patient  will  be  reimbursed  at 
contract  rates.  A non-participating 
physician  who  provides  an  "Emer- 
gency Consultation"  within  the 
above  guidelines  to  an  HMO  patient 
will  be  entitled  to  reimbursement. 
The  patient  will  assume  responsibil- 
ity for  uncovered  hospital  or  physi- 
cian consultant  services  or  appli- 
cable copayments  as  specified  in  the 
HMO  member's  contract.  Reim- 
bursement at  a contracted  or  negoti- 
ated rate  does  not  constitute  an 
uncovered  service. 

Resolution  of  issues 

As  a result  of  this  issue,  CMS  has 
established  a committee  to  develop 
ongoing  communication  between 
CMS,  CO-ACEP  and  the  Colorado 
HMO  Association  to  continue  to 
seek  solutions  to  patient  and  physi- 
cian issues  involving  HMO  mem- 
bers. 

We  hope  this  guideline  will 
alleviate  patient  and  physician 
concerns  about  emergency  consulta- 
tion for  the  HMO  patient. 


Issues  arising  between  physicians 
and  HMOs  under  these  guide- 
lines should  be  referred  to  this 
committee,  comprised  of  repre- 
sentatives from  ACEP,  CMS  and 
the  Colorado  HMO  Association. 
The  committee  will  establish  a 
process  and  procedure  for 
mediation  or  arbitration  of  such 
matters.  Issues  should  be  referred 
to  the  Executive  Director  of  CMS 
at  (303)  779-5455. 


Colorado  Medicine  for  April,  1993 


153 


L et's  talk  about 

America's  health  system 


The  perception  that  the  United 
States  is  having  a health  care  crisis 
arose  from  the  observation  that 
approximately  1 2 percent  of  the 
gross  national  product  now  is  spent 
on  health  care  whereas  approxi- 
mately 5 percent  of  the  gross  na- 
tional product  was  spent  on  health 
care  in  1951.  Reprinted  is  a graph 
and  projected  graph  of  Total  Health 
Care  Spending  as  a Percentage  of 
GNP  Projected  on  Basis  of  Past 
Decade  developed  by  the  Demo- 
cratic Study  Group,  United  States 
House  of  Representatives.  The 
increased  spending  began  in  1965. 


Three  things  happened  in  1965: 

1 . Medicare  was  enacted.  This 

legislation  poured  huge  amounts  of 
money  into  the  health  care  system 
and  created  large  increases  in 
administrative  costs  for  the 


government,  hospitals,  and 
physicians. 

2.  At  the  policies  of  the  Johnson 
administration,  medical  schools 
began  increasing  the  sizes  of  their 
classes.  By  1972,  the  number  of 
medical  school  graduates  had 
doubled.  By  1975  economists 
expressed  alarm  at  the  physician 
surplus. 

3.  Licensure  requirements  for  foreign 
medical  graduates  were  eased. 

Subsequent  developments 
further  stimulated  the  growth  of 
health  care  spending: 


1 . Development  of  physician  extend- 
ers (physician's  assistants  and  nurse 
practitioners)  and  practitioners  of 
alternative  health  care  methods, 
including  but  not  limited  to, 
chiropractors,  podiatrists,  psycho- 
therapists, naturopaths,  homeo- 
paths, nurse  midwives  (and  in  some 


states  lay  midwives),  aroma 
therapists,  kinesthesiologists,  and 
other  nonmedical  health  care 
practitioners.  These  practitioners 
account  for  1 0 percent  of  the 
United  States  health  care  expendi- 
tures. 

2.  The  advent  of  managed  care  plans. 
These  plans  impose  a large, 
complicated,  and  expensive  layer 
of  administrative  personnel  into  the 
patient-physician  relationship. 
Administrative  costs  since  the 
advent  of  these  plans  have 
increased  35  percent  per  year 
while  the  cost  of  delivering  health 
care  has  increased  10  to  1 1 percent 
per  year.  Insurance  premiums  for 
these  plans  have  increased  25 
percent  per  year.  Administrative 
costs  and  profits  account  for  1 0 to 

1 5 percent  of  premium  dollars  for 
indemnity  insurance  plans  and  40 
to  50  percent  for  managed  care 
plans.  Administrative  costs  now 
account  for  28  percent  of  health 
care  expenditures  in  the  United 
States. 

3.  Continued  subsidy  of  the  tobacco 
industry.  The  price  tag  for  diseases 
caused  by  tobacco  products  is 
conservatively  estimated  at  12  to 

1 3 percent  of  health  care  expendi- 
tures. 

4.  Violence  and  traffic  accidents 
continue  to  rise. 

5.  The  Resource  Based  Relative  Value 
Study  (RBRVS)  has  created 
confusion  and  chaos.  Insurance 
carriers  now  are  developing  their 
own  interpretations  and  regula- 
tions. More  than  1 500  could  be 
developed,  one  or  more  from  each 
carrier. 


110% 

90% 

TOTAL  HEALTH  SPENDING 

AS  A PERCENTAGE  OF  GNP 

80% 

PROJECTED  ON  BASIS  OF 

— 

PAST  DECADE 

70% 

— 

/ 

60% 

- 

/ 

50% 

— 

/ 

— 

ACTUAL 

40% 

— 

— 

PROJECTED 

30% 

— 

20% 

- 

10% 

- — 

i i j i 

i i t i i i i i i i i i i i 

1960  1965  1970  1975  1980  1985  1990  1995  2000  2005  2010  2015  2020  2025  2030  2035  2040  2045  2050  2055  2060 

Reprinted  from  DSG  Special  Report,  May  24,  1991,  No  102-6 


154 


Colorado  Medicine  for  April,  1993 


by  Thomas  M.  Golbert,  M.D.,  fohn  Ford,  III,  M.D.,  Lynn  Parry,  M.D. 


Correctable  causes  of  health  care  expenditures  seem  accountable  as  shown 
in  the  following  illustration: 


1. 

Diseases  caused  by  smoking  and  other  uses  of  tobacco  1 2.5  % 

2. 

Diseases  caused  by  alcohol 

12.5  % 

3. 

Administrative  costs,  much  of  which  are 

caused  by  managed 

care  plans 

28  % 

4. 

Alternative  health  care  providers 

10  % 

5. 

Disobeying  traffic  regulations 

10-12  % 

6. 

Addiction  to  illegal  drugs 

? 

7. 

Male  homosexuality  and  other  forms  of 

sexual  promiscuity 

? 

Total: 

more  than  75  percent 

of  all  health  care 

expenditures  in  the 

United  States. 

Items  6.  and  7.  account  for  approximately  95  percent  of  HIV  infection  in  the 
United  States.  The  cost  of  AIDS  is  enormous. 


Three  things  happened  in 
1 965  to  increase 
health  care  spending: 

• Medicare  enacted 

• Med  school  class  size 
increased 

• FMG  licensure  eased 


In  our  opinion,  the  solution  must 
include: 

1 . Reduce  size  of  medical  school 
classes  to  pre-  1965  levels, 
beginning  with  the  1 993  freshman 
class. 

2.  Restrict  licensure  in  the  United 
States  of  foreign  medical  gradu- 
ates. 

3.  Subsequent  increases  in  medical 
school  graduates  must  be  based 
on  realistic  health  care  delivery 
needs  as  the  population  expands. 
The  Canadian  experience  has 
demonstrated  that  costs  are 
controlled  only  by  restricting  the 
supply  of  physicians. 

4.  Require  alternative  health  care 
practitioners  to  prove  scientific 
validity  of  their  methods. 

5.  Eliminate  managed  care  health 
insurance  plans. 

6.  Re-establish  health  insurance 


plans  which  include  expense  to 
the  patient,  such  as  a deductible 
and  co-pay. 

7.  Terminate  subsidy  of  the  tobacco 
industry. 

8.  Enforce  traffic  regulations. 

9.  Pass  and  enforce  national  helmet 
laws 

10.  Implement  or  increase  effective 
drug  abuse  resistance  education 
efforts. 

1 1 . Establish  effective  controls  and 
enforcement  of  illegal  drugs. 

12.  Establish  effective  AIDS  preven- 
tion education,  with  primary 
emphasis  on  chastity  and  mo- 
nogamy. 

1 3.  Abandon  the  RBRVS  in  favor  of 
the  AMA  Current  Procedural 
Terminology  (CPT)  1992  as 
evolved  over  25  years  to  serve  the 
needs  of  physicians  and  carriers. 


Colorado  Medicine  for  April,  1993 


155 


lassified  Advertising 


Publication  of  any  advertisement  in  Colorado  Medicine  is  not  an  endorsement  by  the  Colorado  Medical  Society 
of  the  product  or  service.  Colorado  Medicine  magazine  is  the  official  journal  of  the  Colorado  Medical  Society,  and 
is  authorized  to  carry  General  Advertising. 


♦ PROFESSIONAL  OPPORTUNITIES 


O'CONNOR  & ASSOCIATES— Medical 
ManagernentConsulting.  Services  include: 
free  initial  consultation,  financial,  personnel 
and  contract  management;  planning  & 
implementing.  William  J.  O'Connor,  PhD, 
7436  S.  Clarkson  Cir.  Littleton,  CO  801  22 
(303)  797-861  1 3/0293 

PART-TIME  REGIONAL  MEDICAL  AD- 
VISOR — Physician  needed  to  work  under 
contract  for  the  Social  Security  Admin- 
istration, Disability  Insurance  Program. 
Major  duries  include  (1 ) assist  in  orienting 
new  regional  office  medical  consultants  to 
medical  aspects  of  the  SSA  disability 
program;  (2)  provide  second  review  on 
questionable  cases;  (3)  participate  in  training 
of  state  DDS  medical  consultants;  and  (4) 
provide  medical  guidance  to  pertinent  non- 
medical personnel.  No  contact  with 
patients.  Prior  experience  with  SSA 
disability  program  mandatory.  Twenty  to 
twenty-five  hours  per  week  at  $69.87  per 
hou  r.  cu rricu  I u m vitae  shou  Id  be  sent  to  the 
Regional  Contracting  Officer  on  or  before 
May  15,  1993.  For  more  information 
contact,  Regional  Contracting  Officer, 
Federal  Building,  Room  1010,  1961  Stout 
Street,  Denver,  Colorado  80294-3538, 
Phone  (303)  884-2836.  1/0493 

PART-TIME  MEDICAL  CONSULTANTS— 
Physicians  and  qualified  Professionals 
needed  to  work  under  contract  for  the 
Social  Security  Administration,  Disability 
Insurance  Program  in  the  fields  of 
Psychiatry,  Internal  medicine,  Clinical 
Psychology.  Involves  review  of  medical 
evidence  in  disability  claims  at  a central 
location  in  Denver.  No  contact  with 
patients.  Five  to  twenty  hours  per  week  at 
$59.86  per  hour.  Interested  parties  should 
submit  curriculum  vitae  to  Regional 
Contracting  Officer,  Federal  Building,  Room 
1 01 0, 1 961  Stout  Street,  Denver,  Colorado 
80294-3538,  on  or  before  May  1 5,  1 993. 
For  more  information  telephone  (303)  844- 
2836.  1/0393 


EMERGENT/URGENT  CARE  PHYSICIAN 
Full  and  part  time  position  in  Lafayette. 
Flexible  scheduling.  Send  CV  or  Contact 
Dr.  Coryell,  Community  Medical  Center, 
2000  W.  S.  Boulder  Rd.,  Lafayette,  CO 
80206,  (303)  666-4357.  I 2/0892 

FAMILY  PRACTICE  OPPORTUNITY  IN 
CANON  CITY — We  need  one  family 
physician  to  practice  in  the  Climate  Capital 
of  Colorado.  Privileges  at  St.  Thomas  More 
Hospital,  obstetric  services  desirable  but 
not  required.  Unlimited  opportunities  for 
recreation.  Growing  community.  For  more 
information,  please  call  or  write  Gary  Alan 
Mohr,  MD,  FAAFP,  730  Macon  Avenue, 
Canon  City,  CO  81212,  (719)  275-1618 
Tfn/0892 

FAMILY  PRACTICE— HOSPITAL  SPON- 
SOREDCLINICOPPORTUNITY.  Dynamic, 
growth  oriented  hospital  in  beautiful  North 
Central  Wisconsin  is  seeking  Family 
Physicians  to  respond  to  growing  com- 
munity demand.  The  administrative  burdens 
of  medical  practice  will  be  minimized  in 
this  hospital  managed  clinic.  The  hospital 
has  committed  to  an  income  and  benefit 
package  which  is  significantly  higher  than 
similar  opportunities.  Package  includes 
base  income,  incentive  bonus,  malpractice, 
disability,  signing  bonus  and  student  loan 
reduction/forgiveness  program.  All  relo- 
cation costs  will  be  borne  by  the  hospital. 
Please  contact  Kari  Wangsness,  Associate, 
The  Chancellor  Group,  Inc.,  France  Place, 
Suite  920,  3601  Minnesota  Drive, 
Bloomington,  Minnesota,  55435,  (612) 
835-5123.  tfn/1190 

LOCUM  TENENS...  new  adventures,  free 
from  administrative  tasks,  flexibility,  and 
high  earnings.  Assignments  vary:  one  day, 
one  week,  one  month,  long  term,  OR,  time 
off  with  peace  of  mind,  knowing  that  your 
practice  goes  uninterrupted.  Qualified 
physicians  are  ready  to  assist.  Ten  years 
experience;  physician-managed  company. 
Call  INTERIM  PHYSICIANS  today  for 
detai  Is.  — Denver  69 1 -07 1 8,  or  1 -800-669- 
0718  12/1292 


TIRED  OF  THE  DAY  TO  DAY  HASSLE  of 

HMO's,  Medicare,  discounted  insurance 
and  being  on  cal  I (Then  consider  a position 
with  corrections.  Before  you  say  "No  Way," 
call  us  and  find  out  more.  Contact  Roderic 
Gottula,  MD,  10900  Smith  Road,  Denver, 
CO  80239  or  call  (303)  375-21 1 0.6/01 93 

BOULDER- AMBULATORYCARECLINIC- 
Family  Medicine/Emergent  Care/Occu- 
pational Medicine  - Busy,  two  physician 
practice  seeking  full  time  BE/BC  Family 
Practitioner  to  join  growing  comprehensive 
medical  practice  in  prime  SE  Boulder  area. 
New,  well  equipped  facility.  Minimal  call. 
Flexable  scheduling.  Send  CV  and  call  Dr. 
Turnbow,  4800  Baseline,  D-106,  Boulder, 
Co  80303  (303)  449-4800.  3/0293 

DIAGNOSTIC  RADIOLOGY  POSITION, 
CRAIG,  CO.  1 st.  Yr.  1 1 0k,  Benefits,  6 weeks 
off:  2nd  Yr.  120k,  Benefits,  8 weeks  off. 
Equal  shares  thereafter.  Reply;  Royal  Smith, 
MD.  Memorial  Hosp.  785  Russell  St.  Craig, 
Co.  81  625  or  call  (303)  945-6535  ext.  31  2, 
Days  or  945-8296  evenings.  3/0293 

PHYSICIANS,  SURGICAL/ANESTHES- 
IOLOGY RESIDENTS,  (MD/DO).  Excep- 
tional part-time  practice.  Colorado  and 
Nationwide.  Outstanding  fringes,  educ. 
assistance.  Air  National  Guard.  Call  Edd 
(307)772-6185.  9/0293 

OPPORTUNITY  FOR  EMPLOYMENT,  part 
time,  in  an  outpatient  Rectal  Clinic  in 
Denver,  Colorado.  For  information : Joseph 
j.  Major,  D.O.,  P.C.,  FACOS.  651  Potomac 
- Suite  C,  Aurora,  CO.  8001 1 - Phone;  303- 
344-8274.  1/0493 

EMERGENCY  MEDICINE  work  by  M.D.- 
ER  Physician.  Experience: 25  yrs. combined 
Er/minor/urgent  center.  Desire:  Personal 
contract  with  hospital  or  group  operating 
hosp.  ER  &/or  Minor/Urgent  center.  Salary 
& Ins. -negotiable.  Write:  Box  F.  C/O. 
Colorado  Medical  Society,  P.O.  Box  1 7550, 
Denver  CO  80217-0550.  4/0293 


156 


Colorado  Medicine  for  April,  1993 


Classified  Advertising 


DIAGNOSTIC  RADIOLOGY  - Immediate 
opening  for  part-time  work  as  a General 
Diagnostic  Radiologist  in  a hospital  based 
practice,  30  minutes  north  of  Denver,  in  a 
pleasant,  state-of  the-art  radiology 
department.  Send  CV  to  Diagnostic 
Radiology  Physicians  P.C.,  1960  Altura 
Blvd.,  Aurora,  CO  8001 1 . 3/0493 

♦ SITUATIONS  WANTED 

♦ PROPERTIES  FOR  SALE  OR  LEASE 

Professional  Office  Space 

Excellent  location  in  Wash  Park/DU  area. 
Share  common  pt.  waiting  room  w/  2 
internists  and  1 DDS.  Three  1 0'  X 1 0'  ops, 
reception  area.  Very  reasonable.  Call  Russ, 
688-8976.  12/0792 

PUERTO  VALLARTA,  MEXICO-  2003  sq. 
ft.  Beach  front  condominium.  Sleeps  1 1 ; 4 
baths;  maid  service,  December  1 8-January 
3 $1500.00.  For  details  call  (719)  542- 
1810.  1/0493 

MAUI,  HAWAII.  Luxurious  2 BR/2  BA,  2,1 00 
sq.ft,  condominium  in  Kaanapali  Beach 
Resort,  1 00  yards  from  beach. Everything's 
new!  Pool,  Jacuzzi,  Sauna,  Lighted  Tennis 
Courts,  Maids.  On  16th  fairway  of  the 
Royal  Kaanapali  Golf  Club.  Special  Spring/ 
Summer  Rates.  Call  985-9531 . 6/0393 

EAGLE/VAIL  fully  equipped  luxury 
townhouse  on  golf  course,  4 bedrooms,  3 
baths,  reasonable  summer-winter  rates. 
Peter  Gehret,  MD  (303)  771-0456. 

1 2/0492 

VAIL  FOR  SALE-  50%  interest  in  3500  sq. 
foot  vacation  home  above  the  Westin  Hotel. 
5 bedrooms,  3.5  baths,  4-car  garage, 
jacuzzi,  large  decks,  walk  to  Westin  lift. 
Call  Doug  Kirkpatrick.  Evenings  (303)  762- 
9050.  4/0193 


FOR  SALE:  Medical  Office  Building  located 
in  the  beautiful  Mtn.  community  of 
Woodland  Park,  Co.  18  Mi.  to  Colorado 
Springs  and  25  Mi.  to  Cripple  Creek.  Sale 
necessary  due  to  husband's  death.  For 
information  contact  Mrs.  R.  J.  Groeger — 
1 21 0 W.  Lorraine  Woodland  Park,  Co.  or 
call  (719)  687-2687.  6/0293 

♦ EQUIPMENT  FOR  SALE  OR  LEASE 

BUY  DIRECT— LOCAL  MFGR.  Custom 
Office  Furniture — Desks,  Credenzas, 
bookcases,  Files,  work  stations,  waiting 
room  seating,  etc.  Oak-cherry  & walnut. 
We  build  quality  custom  office  furniture  at 
a price  you  can  afford.  Mark  IV  Systems, 
Inc.  297-1 248.  8:00-4:30  M-F.  1 2/0293 

FOR  SALE:  Multiple-station  Pulmonary 
Function  Testing  System.  Twenty  office- 
based  spirometry  units  with  volume 
spirometer,  computer  workstation,  cali- 
bration syringe  and  modem.  Central 
computer  facility  with  storage,  modems 
and  printer.  May  be  acquired  with  existing 
accounts  on  contract  to  provide  pulmo- 
nologist overread.  All  offers  will  be 
considered.  For  more  information,  contact: 
Peter  Canaday,  M.D.,  Western  Pulmonary 
Services,  501  S.  Cherry  St.  #700,  Denver, 
CO  80222.  (303)  892-0547.  3/0393 

♦ PRACTICES  FOR  SALE 

BUSY  X-RAY/MAMMO  DEPT,  for  sale  in 
Thornton,  CO.  For  more  information  call 
Bobbie  at  (303)  252-0083. 

♦ SERVICES 

QUICK  CLAIM  ELECTRONIC  CLAIMS 
PROCESSORS,  HMO  PPO,  MEDICARE, 
MEDICAID  AND  PATIENTS  BILLING  (303) 
333-8666.  22/0393 

HOME  MORTGAGE  LOANS 
LOW  DOC  PROGRAM  available  for 
physicians  and  other  health  professionals. 
Purchase  and  refinance.  Call  Milt,  a 
mortgage  banker  with  1 8 years  experience. 
7 53-6262.  12/1292 


MEDICAL  LITERATURE  RESEARCH  — 
Want  to  review  literature  for  clinical  or 
legal  problems,  presentation  or  publication? 
Experienced  physic  ian/author/educator  will 
do  customized  multiple  database  search  at 
reasonable  rates.  Call:  Bill  Milburn,  MD  at 
823-5083;  1-800-828-9259  (outside 
Boulder/Longmont).  12/0792 


Cash  Crunch? 

Overhead  Rising? 

Revenue  Dropping? 

Let  us  help  lower  your  costs.  YOU 
specialize  in  patient  care.  WE  specialize 
in  insurance  billing.  We  work  with 
Medicare,  Medicaid,  HMO's,  PPO's, 
and  other  third  party  carriers. 

We  don't  get  paid  until  you  get  paid. 
For  more  information  call  Advanced 
Professional  Services  (303)  755-0093. 

tfn/0492 

INOVATIONS  SHOULD  BE  PATENTED  if 

marketable.  For  more  information  call  Brian 
D.  Smith  of  Fields,  Lewis,  Pittenger  & Rost. 
Colo's  leading  patent  law  firm.  Mr.  Smith 
specializes  in  the  medical  arts.  (303)  758- 
8400.  12/1192 

Practice  Valuations  $389  - Includes 
accounts  receivable,  medical  and  office 
equipment  and  furniture.  Call  Yvonne,  3- 
Minute  Reader  (1-800-848-4912  x-4401 
or  Denver  metro  756-6108.  Out-of-metro 
include  travel  expenses.  4/0393 

♦ MISCELLANEOUS 

EQUIPMENT  NEEDED  URGENTLY  for 

large  community  health  center  located  in 
Longmont.  Our  five-exam  room  facility 
will  soon  expand  to  1 2 exam  rooms  and  we 
are  looking  for  good  used  office  equipment 
and  exam  room  furnishings.  Call  to  discuss 
price/donations  with  Mark  Kissack  at  (800) 
388-4325.  6/0393 


Colorado  Medicine  for  April,  1993 


157 


Ruminations 


(def:  to  chew  again  what  has  been  chewed  slightly  and  swallowed;  to  REFLECT) 


by  Bill  Pierson,  Managing  Editor 


One  of  the  things  I 
aligned  myself  with  early 
in  adult  life  was  the 

philosophy  that  "For  many 
questions  there  can  be 
more  than  one  right  an- 
swer; however ; before 
attempting  a response  to 
the  question ; examine 
your  answer  or  solution  to 
see  if  it  is  based  on  objec- 
tive reality  or  is , instead 
simply  a verisimilitude." 


Monogrammed  towel  said  to  have 
been  seen  in  the  White  House  . 


Let  me  give  you  an  example: 
Several  years  ago,  a survey  was 
taken  in  the  hill  country  of  Kentucky 
and  Tennessee.  In  this  health  care 
survey  the  question  was  asked  "Who 
is  your  primary  care  doctor?"  The 
majority  of  people  interviewed  in  a 
large  area  responded  with  the  name 
of  a local  or  nearby  chiropractor  as 
their  primary  care  doctor. 

Was  this  the  right  answer?  To 
you,  no,  never!  To  those  people  in 
the  hill  country,  yes,  definitely!  Was 
the  answer  based  on  objective  reality 
or  was  it  a verisimilitude?  Objective 
reality,  simply  and  truthfully.  The 
respondents  didn't  know  any  differ- 
ent and  this  doctor  of  chiropractic 
was  the  first  person  they  turned  to 
when  in  need  of  any  kind  of  health 
care. 

I believe  Hillary  Rodham  Clinton 
and  the  members  of  her  Health  Care 
Reform  (HCR)  Task  Force  will  be 
using  my  philosophy  of  "There's 
more  than  one  right  answer"  in 
reforming  health  care.  Watch 
carefully  during  May,  1993  when,  I 
predict,  the  Task  Force  will  come  out 
with  a whole  new  health  care 
philosophy  based  on  "there's  more 
than  one  right  answer,"  manifesting 
itself  in  a redefinition  of  current 
health  care  terms,  starting  with 
"primary  care". 

Typically,  primary  care  will  be 
defined  as  something  which  can  be 
provided  by  a number  of  multi-level 
providers,  so  it  will  no  longer  be 
your  "primary  care  physician;" 
instead,  it  will  be  your  "primary  care 
provider." 

It's  happening  in  Colorado,  too. 
At  the  meeting  of  the  Colorado 
Medical  Society  Committee  on 


Health  Care  Reform  February  25, 
1993,  Barbara  Yondorf,  Director  of 
Policy  and  Research  for  the  Colorado 
Insurance  Commissioner,  spoke 
about  ColoradoCare.  Ms.  Yondorf 
was  one  of  the  principals  in  creating 
the  ColoradoCare  proposal  in  1990. 
She  provided  the  CMS  committee 
with  a variety  of  other  "right  an- 
swers" to  standard  health  care 
questions.  Typically,  the  meaning  of 
"universal  coverage"  takes  on  a new 
light  when  you  discover  that  "'uni- 
versal' means  health  insurance 
coverage  for  everyone,  but  not 
everyone  is  covered  by  the  same 
health  insurance  plan.  And,  we  ask, 
what  are  the  differences  in  these 
coverage  plans? 

Let's  go  back  to  primary  care.  I 
have  heard  it  said  by  many  that 
business  would  be  better  off  con- 
tracting directly  with  hospitals  and 
doctors  . There  are  networks  forming 
up  now  in  preparation  for  a new 
approach.  In  that  relationship  I heard 
someone  say  recently,  "whoever 
corners  the  primary  care  market  will 
corner  the  health  insurance  market." 
That  could  well  be  true,  and  there's 
already  work  afoot  toward  that  goal. 
But  it  is  being  done  (by  someone 
other  than  doctors)  first  redefining 
primary  care,  then  naming  those 
providers  who  fall  within  that  new 
definition  and  then  creating  a 
provider  network  or  plan  to  fit. 

Seems  to  me  that  the  new  wave 
health  care  philosophy  is  a variation 
on  my  own  theme  of  "There's  more 
than  one  right  answer".  It  is  simply 
"Well,  you  were  right  by  the  old 
definition,  but  the  way  we  see  it,  it 
doesn't  mean  that  any  more.  This  is 
what  it  means  under  our  plan." 


158 


Colorado  Medicine  for  April,  1993 


{ o In  This  Issue: 

Become  a leader p.  173 

Born  at  a very  young  age  in  Telluride p.  1 78 

What's  your  hobby?  p.  183 


gnssj'1' 


' Need  The  Lowest  6^f- 

vV#  Go  t0^n  q.  Doe,  WLD*  y 

intact  John'-*  T 


Can  you  imagine  a physician  who  would  run  a classified  advertisement  like  that? 

►4  Of  course  not.  And  yet,  some  Colorado  physicians  choose  their  malpractice 
insurance  carrier  that  way  Unfortunately,  when  they  sort  through  the  fine  print 
of  their  policy  they  often  discover  that  Brand  X wasn’t  even  the  low  bidder,  let 
alone  the  most  competent  to  avoid  or  defend  malpractice  suits,  or  to  provide 
vital  services  to  policyholders  and  the  Colorado  physician  community  By 
all  means,  comparison  shop  if  you’re  in  the  market  for  malpractice  insurance. 
But  when  you  do,  be  certain  that  you  make  your  choice  based  on  all  the  facts 
and  figures.  ♦♦♦  We  are  confident  that  you  will  choose  Copic.  More  often  than 
not,  we  will  be  the  low  bidder,  once  you  reach  the  real  bottom  line. 


The  Copic  Bottom  Line . 

It’s  more  than  just  competitive  rates . 


Copic  Insurance  Company 

RO.  Box  17540  • Denver,  CO  80217-0540  • (303)  779-0044  • 1-800-421-1834 


Colorado  Medicine 

May,  1993  Volume  90,  Number  5 


Cover  Story 


In  This  Issue... 

168  Do  Trees  Grow  to  the  Sky? 

Leigh  Truitt,  MD 
President 

1 72  Some  Day  in  May 

Thomas  H.  Coleman,  M.D. 


National  Healthcare  Reform: 
How  much  attention  is  paid 
to  the  people  most  involved 
and  affected — the  physicians 
and  the  patients? 


1 74  AMA:  Time  For  New  Partnership 

Frederick  A.  Lewis,  Jr.,  MD 

177  Health  Care  Quiz 

178  Physician  Profile:  Jim  Parker,  MD 


Departments 


1 68  President's  Letter 

170  Executive  Director's  Update 

171  Guest  Editorial 

180  Health  Care  Financing 
184  Committee  Update 

1 86  Proceedings  of  the  House  of  Delegates 

187  Board  Highlights 

1 88  Delegate  Attendance — Interim  Meeting 
192  Health  Department 

1 94  Letters 

195  Medical  News 

196  Classified  Advertising 
198  Ruminations 


181  CPR/DNR  ID  Project 

182  Doctors'  Day  Hobby  Exhibit 
190  Science  Fair  Held  in  Fort  Collins 


Colorado  Medical  Society 


Ik  J, 


vVxn"  sYptJ^-' 


COLORADO  MEDICAL  SOCIETY 
OFFICERS,  BOARD  MEMBERS  and  AMA  DELEGATES 


1992/1993  Officers 
Leigh  Truitt,  M.D. 

President 

Wm.  Carl  Bailey,  MD 

President-elect 

Terrance  J.  Sullivan,  M.D. 

Treasurer 

Stuart  O.  Silverberg,  M.D. 

Speaker  of  the  House 

David  C.  Martz,  M.D. 

Vice-speaker  of  the  House 

Sandra  L.  Maloney 

Secretary/Executive  Director 

Harrison  G.  Butler,  III,  M.D. 

(Immediate  Past  President) 


Board  of  Directors 

Thomas  J.  Allen,  MD 
Stephen  G.  Batuello,  MD 
John  O.  Cletcher,  Jr.,  MD 
Donald  G.  Eckhoff,  MD 
John  E.  El  I iff,  MD 
Jonathan  C.  Feeney,  MD 
David  C.  S.  Franklin,  MD 
Joel  M.  Karlin,  MD 
George  M.  Kreye,  MD 
Muryl  L.  Laman,  MD 
Ted  T.  Lewis,  MD 
Maura  J.  Lofaro,  MS  IV 
Louise  L.  McDonald,  MD 
Robert  A.  Nathan,  MD 
Kenneth  M.  Olds,  MD 
James  R.  Regan,  MD 
Lothar  K.  Roller,  MD 


Board  of  Directors 

David  Shander,  MD 
W.  George  Shanks,  MD 
Susan  A.  Sherman,  MD 
Denis  J.  Winder,  MD 
M.  Robert  Yakely,  MD 

AMA  Delegates 

M.  Ray  Painter,  Jr.,  MD 
Richert  E.  Quinn,  Jr.,  MD 
Mark  A.  Levine,  MD 

Alternate  Delegates 

Robert  D.  McCartney,  MD 
Robert  M.  Bogin,  MD 
Joel  M.  Karlin,  MD 

Legal  Counsel 

Robert  R.  Montgomery 


COLORADO  MEDICAL  SOCIETY  STAFF 


Executive  Office 

Sandra  L.  Maloney,  Executive  Director 
Mary  Lee  Johnston,  Executive  Admin.  Asst. 
Nancy  L.  Deter,  Manager,  Accounting 

Western  Slope  Office 

Dolores  M.  Bennett,  Executive  Secretary 

Division  of  Membership  Information  Services 

Timothy  H.  Roberts,  Director 
Diane  L.  LeHew,  Manager,  Support  Services 
Debra  M.  lones,  Membership  Coordinator 
Beth  M.  Crusha,  Administrative  Assistant 


Division  of  Health  Care  Policy 

Ellen  J.  Stein,  Director 

Marilyn  P.  Barton,  Program  Manager 

Lynn  R.  Livingston,  Administrative  Assistant 

Division  of  Health  Care  Financing 

Edie  K.  Register,  Director 

Marijo  M.  Parkin,  Program  Manager 

Division  of  Government  Relations 

Sue  Ellen  Quam,  Director 

Lorraine  L.  Koehn,  Program  Manager/Lobbyist 

K.  Suzanne  Hamilton,  Administrative  Assistant 


Division  of  Professional  Services 

Sandra  M.  Finney,  Director 
Lorraine  K.  Heth,  Program  Manager 
Kirsten  E.  Regalado,  Secretary 


Division  of  Communications 

William  S.  Pierson,  Director 

Michael  P.  Thompson,  Communications  Spec. 

Gil  Maestas  II,  Communications  Staff 


COLORADO  MEDICINE  (ISSN-01 99-7343)  is  published  monthly  as  the  official  journal  of  the  Colorado  Medical  Society,  7800  E.  Dorado  PI.,  Englewood,  CO  801 1 1 . Telephone  (303)  779-5455.  Outside 
Denver  area,  call  1 -800-654-5653.  Second  Class  postage  paid  at  Englewood,  Colorado,  and  at  additional  mailing  offices.  POSTMASTER,  send  address  changes  to  COLORADO  MEDICINE,  P.  O.  BOX 
17550,  Denver,  CO  802 1 7-0550.  Address  all  correspondence  relating  to  subscriptions,  advertising  or  address  changes,  manuscripts,  organizational  and  other  news  items  regarding  the  editorial  content 
to  the  editorial  and  business  office.  Subscriptions  are  available  for  $30  per  year,  paid  in  advance. 

COLORADO  MEDICINE  magazine  is  the  official  journal  of  the  Colorado  Medical  Society,  but  as  such  is  also  authorized  to  carry  general  advertising.  Publication  of  any  advertisement  in  COLORADO 
MEDICINE  does  not  imply  an  endorsement  or  sponsorship  by  the  Colorado  Medical  Society  of  the  product  or  service  advertised.  Published  articles  represent  opinions  of  the  authors  and  do  not  necessarily 
reflect  the  official  policy  of  the  Colorado  Medical  Society  unless  clearly  specified. 

Sandra  L.  Maloney,  Executive  Editor;  William  S.  Pierson,  Managing  Editor;  Michael  Thompson,  Asst.  Managing  Editor 


Member,  Colorado  Press  Association, 


Member,  Colorado  Broadcasters  Association 


164 


Colorado  Medicine  for  May,  1993 


ROCHE  LABORATORIES 


presents  the  winners  of  the  1992  President's  Achievement  Award 


Please  join  us  in  honoring  these  outstanding  Roche  representatives  who  have  distinguished  themselves 
by  a truly  exceptional  level  of  professionalism,  performance  and  dedication  to  quality  healthcare. 
Throughout  the  year,  each  of  these  award-winning  individuals  has  consistently  exemplified  the  Roche  Commitment 
to  Excellence  and  we're  proud  to  invite  you  to  share  in  congratulating  them  on  their  achievement. 


M.  Jane  Higgins  Roger  Person 

Denver,  Colorado  Loveland,  Colorado 


H.  Riggs  Smith 
Littleton,  Colorado 


FLIGHT  SURGEONS 
WANTED. 

Discover  the  thrill  of  flying,  the  end  of 
paperwork  and  the  enjoyment  of  a gener- 
al practice  as  an  Air  Force  flight  surgeon. 
Take  flight  with  today’s  Air  Force  and  dis- 
cover quality  benefits,  30  days  of  vaca- 
tion with  pay  each  year  and  the  support 
of  a dedicated  staff  of  professionals. 

Enjoy  a true  general  practice  on  the 
ground,  with  the  kind  of  stimulating  chal- 
lenge that  will  get  your  medical  skills  air- 
borne. Talk  to  an  Air  Force  medical  pro- 
gram manager  about  becoming  an  Air 
Force  flight  surgeon.  Call 

1-800-423-USAF 
USAF  Health  Professions 


Access  to  Food 
Constitutes 
a Human  Right 

World  hunger  is  an 
ever-present  scourge  that 
claims  35,000  lives  each  day. 

Access  to  food  constitutes  a human  right. 
In  1 976,  the  United  States  Congress 
passed  a Right  to  Food  Resolution  which 
declared  the  sense  of  the  congress  to  be 
"that  all  people  have  a right  to  a 
nutritionally  adequate  diet". 

Physicians  Against  World  Hunger  (PAWH),  a non-profit,  tax- 
exempt  organization  was  founded  so  that  physicians  could 
collectively  defend  this  human  right  by  raising  funds  to  support 
well -recognized,  reputable  organizations  that  are  directly 
engaged  in  working  with  the  poor  primarily  for  the  purpose  of 
ending  death  by  starvation. 

Please  join  us — together  physicians  must  help  bring  an  end  to 
world  hunger. 


Physicians  Against  World  Hunger 

#2  Stowe  Road,  Peek  skill,  NY  1 0566 

YES  I wish  to  join  PAWH  in  the  struggle  to  end  world  hunger 
— enclosed  is  my  contribution. 

□ $50  Cl  $100  □ $250  □ $500  □ Other 


NAME  PLEASE  PRINT 


ADDRESS 


CITY  STATE  ZIP 


SIGNATURE 

Please  forward  your  tax  deductible  contribution  to 

Physicians  Against  World  Hunger 

#2  Stowe  Road,  Peekskill,  NY  1 0566 


166 


Colorado  Medicine  for  May,  1993 


Call  For  Nominations 


1993  Colorado  Medical  Society 

Certificate  of  Service  Award 


The  Certificate  of  Service  is  the  highest  award  given  by  Colorado  Medical  Society  in  recognition 
of  a physician's  outstanding  contribution  to  the  constitutional  purposes  of  the  Society. 

Deadline  for  receipt  of  nominations  for  the  1 993  Colorado  Medical  Society  Certificate  of  Service 
Award  is  June  30,  1993. 

Nominations  should  be  made  by  letter. 

The  Certificate  of  Service  will  be  presented  at  the  Annual  Meeting  to  be  held  September  9-12, 
1993  at  Snowmass,  Colorado. 

Send  nominations  to  the  CMS  Confidential  Awards  Committee,  PO  Box  1 7550,  Denver,  CO. 
80217-0550. 


CALL  FOR  NOMINATIONS 
jT.  ‘J{.  Robins  ftzvard 

Presented  by  the  Wyeth-Ayerst  Laboratories 

The  Colorado  Medical  Society  is  pleased  to  participate  with  the  Wyeth-Ayerst  Laboratories  to  Award  a physician 
member  of  CMS  the 

1993 

Physician  Award  for  Community  Service 

Criteria  for  this  award  are  as  follows: 

1 . The  recipient  must  be  a physician,  licensed  within  the  state  of  Colorado. 

2.  The  recipient  must  be  living.  Awards  will  not  be  presented  posthumously. 

3.  The  recipient  has  not  been  a previous  recipient  of  the  award. 

4.  The  recipient  has  compiled  an  outstanding  record  of  community  service  which,  apart  from  his/her  specific 
identification  as  a physician,  reflects  well  on  the  profession. 

The  A.H.  Robins  Award  will  be  made  at  the  1993  Annual  Meeting,  September  9-12,  1993,  at  Snowmass,  Colorado. 

Deadline  for  receipt  of  nominations  is  June  30,  1 993. 

Nominations  (with  supporting  information)  should  be  sent  to  the  Confidential  Awards  Committee,  Colorado 
Medical  Society,  PO  Box  17550,  Denver,  CO  80217-0550 


Colorado  Medicine  for  May,  1993 


167 


RESIDENT 


Letter 


Do  trees  grow  to  the  sky? 


"I  would  like  to  go  out  on 
a limb  and  make  a few 
predictions. " 


Most  economic  theory  is  based 
on  the  concept  of  equilibrium  — 
that  the  law  of  diminishing  returns 
will  make  most  systems  tend  to 
equilibrium.  Diminishing  returns 
means  that  a buyer  would  pay  less 
for  the  next  candy  bar  than  for  the 
preceding  one.  The  end  result  is  that 
trees  don't  grow  to  the  sky.  Recently, 
some  economists  have  suggested 
that,  for  certain  systems  and  for 
certain  periods  of  time,  there  are 
increasing  returns — "To  them  that 
hath  shall  be  given",  or,  less  el- 
egantly, "Them  that  has  gets".1 
Under  these  conditions,  there  are  no 
equilibrium  points.  For  the  last  38 
years,  health  care  costs  have  steadily 
increased  until  now  they  consume 
14%  of  the  gross  national  product. 
The  stimulus  for  this  growth  has  been 
increased  federal  funding  of  health 
care  and  our  ability  to  sell  our 
technology.  Will  this  continue  or  will 
health  care  costs  reach  equilibrium? 

Most  health  care  reform  propos- 
als assume  universal  coverage. 
Estimates  of  the  cost  of  this  coverage 
under  managed  competition  vary  but 
are  in  the  neighborhood  of  $48 
billion.2  With  this  sort  of  stimulus,  if 
all  else  is  held  constant,  we  would 
enter  a new  golden  age  of  health 
care  demand  — at  least  from  our 
perspective.  Our  tree  would  con- 
tinue to  grow  to  the  sky. 

Very  few  observers  believe  that 
those  who  pay  for  health  care  — 
either  public  or  private  — are 
prepared  to  let  this  happen.  Employ- 
ers are  limiting  their  obligations 
through  deductibles  and  copays;  by 
buying  prepaid,  capitated  care 
through  HMOs;  or  are  withdrawing 


from  offering  health  care  benefits  at 
all.  Medicare  has  instituted  volume 
performance  standards  and  forward 
adjusts  the  conversion  factor  for  the 
RBRVS  based  on  last  year's  volume 
performance.  President  Clinton  has 
even  suggested  that  savings  from  the 
federal  health  care  budget  after  his 
health  care  reform  will  help  lower 
the  deficit. 

In  the  April  issue  of  Colorado 
Medicine,  I presented  the  argument 
that  you  may  want  to  consider 
capitated  managed  care  as  an 
alternative  to  fee-for-service  reim- 
bursement with  a floating  conversion 
factor.  I won't  repeat  that  here.  A 
well-managed  HMO  can  serve  about 
800  patients  per  physician.  The  fee- 
for-service  sector  has  only  400 
patients  per  physician,  or  half  as 
many.  Guess  which  physician  will 
be  better  paid  if  each  patient  gener- 
ates the  same  per  capita  reimburse- 
ment?3 

To  continue  my  tree  metaphor,  I 
would  like  to  go  out  on  a limb  and 
make  a few  predictions: 

1 . Health  care  costs  will  be  sub- 
jected to  expenditure  caps. 

2.  The  same  per  capita  amount 
(adjusted  for  age,  sex,  and 
expected  risk)  will  be  allocated 
to  the  fee-for-service  sector  as  to 
the  managed  care  sector. 

3.  The  fee-for-service  sector  will 
have  a floating  conversion 
factor,  i.e.,  as  volume  goes  up 
the  price  or  fee  will  go  down. 

4.  In  the  managed  care  sector, 


168 


Colorado  Medicine  for  May,  1993 


Leigh  Truitt,  MD 
President,  1992-1993 


almost  all  reimbursement  will  be 
by  capitation  or  by  salary  for 
physicians. 

5.  After  an  initial  choosing  up  of  the 
teams,  physicians  and  hospitals 
will  be  locked  into  competing 
networks.  Not  all  players,  and 
especially  specialists,  will  be 
chosen.  Those  networks  will 
thereafter  limit  the  numbers  of 
participating  physicians  and 
hospitals. 

6.  The  relative  number  of  patients  in 
the  managed  care  sector  will 
increase  with  time. 

7.  Those  physicians  who  chose  the 
fee-for-service  sector,  after  an 
initial  burst  of  prosperity,  will 
regret  their  decision,  as  fees 
decrease. 

8.  Although  fully  employed  special- 
ists doing  procedures  will  always 
earn  more,  some  specialists  may 
wish  they  were  primary  care 
physicians. 

9.  Health  care  costs  will  continue  to 
increase  but  only  a little  more 
than  the  overall  rate  of  inflation. 

1 0.  Physicians  will  continue  to  earn 
above  average  incomes  even 
considering  their  work  hours  and 
educational  costs. 

Where  does  this  somewhat 
gloomy  prognosis  leave  us  if  we 
concede  that  our  tree  will  not  grow 
to  the  sky?  How  can  we  invigorate 
our  profession? 


I believe  that  in  the  past  we  have 
been  too  passive  in  our  approach  to 
the  organization  of  health  care.  Our 
ventures  in  managed  care  such  as 
IPAs  and  PPOs  have  been  much  too 
timid,  designed  to  preserve  the  status 
quo.  We  must  become  active  tree 
surgeons,  pruning  both  the  roots  and 
branches  of  our  pot-bound  trees. 

We  must  recognize  that  it  isn't 
what  we  charge  that  escalates  health 
care  costs,  but  what  those  charges 
carry  with  them,  the  procedures, 
tests  and  hospitalizations.  We  must 
stop  counting  on  maintaining  our 
incomes  by  asking  society  to  pour  on 
more  and  more  health  care  dollars. 
Somehow  we  must  give  greater 
value. 

Health  care  will  be  restructured 
either  with  or  without  our  help.  The 
broad  strokes  will  be  handed  to  us.  It 
is  too  late  to  turn  back  the  clock  — 
we  must  make  it  work  within  those 
confines.  Only  by  being  willing 
leaders  and  assuming  risks  can  we 
assure  that  our  patients  will  be  well 
cared  for  and  our  profession  pre- 
served for  those  physicians  who 
follow  us.  If  we  are  thoughtful  and 
energetic,  we  can  create  a new 
golden  age  of  medicine  within  the 
bounds  of  health  care  reform. 


"Health  care  will  be 
restructured  either  with  or 
without  our  help.  The 
broad  strokes  will  be 
handed  to  us.  It  is  too  late 
to  turn  back  the  clock  — '' 


References: 

1 M.  Mitchell  Waldrop,  Complexity:  The 
Emerging  Science  at  the  Edge  of  Order 
and  Chaos.  (New  York:  Simon  & Schuster, 
1992),  p.  17. 

2 John  F.  Shiels,  Lawrence  S.  Lewin,  and 
Randall  A.  Haught,  " Potential  Public 
Expenditures  Under  Managed  Competi- 
tion, " Health  Affairs,  Supplement  1993, 
pp.  229-242. 

3.  Uwe  E.  Reinhardt,  "Reorganizing  the 
Financial  Flows  in  American  Health 
Care, " Health  Affairs,  Supplement  1993, 
p.  1 90. 


Colorado  Medicine  tor  May,  1993 


169 


Photo  by  Rocky  Mountain  News 


Sandra  L.  Maloney 
Executive  Director 
Colorado  Medical  Society 


XECUTI  VE 


Director's 


LJ  pd  a 


Carol  Packard  Tempest 
August  12,  1927  - March  30,  1993 


Events  of  the  last  days  of  March 
and  the  first  days  of  April  came  and 
went  with  such  a rush.  Time  does 
that  any  more  ...  "where  did  the 
week  go?"  People  do  that,  too. 

Word  reached  me  on  March  31 
that  Carol  Tempest  had  succumbed 
to  some  natural  cause,  and  she 
passed  from  our  lives.  We  were  just 
packing  up  things  to  hold  the  Interim 
Meeting,  this  year  by  some  quirk  of 
fate  to  be  held  outside  Denver  for  the 
first  time  in  anyone's  good  memory. 
No  one  was  prepared  for  Carol's 
sudden  death.  She  had  been  very 
much  alive  and  active  in  body  and 
spirit  just  the  week  before  at  the 
capital,  helping  CMS  on  a couple  of 
major  legislative  issues.  And  then, 
suddenly,  I was  told  I wouldn't  see 
her  any  more. 

But  I will  see  Carol  in  many 
ways,  as  you,  the  members  of  CMS 
and  the  proud  medical  profession, 
will  continue  to  see  her  imprint  over 
the  years.  Carol  left  behind  her  a 
very  substantial  legacy  in  meaningful 
medical  and  health  care  legislation 
in  which  she  was  a major  player. 
Carol  was  the  Director  of  Govern- 
ment Affairs  and  the  lead  lobbyist  for 
CMS  for  twelve  years.  She  was 
knowledgeable  in  federal  and  state 
government  affairs,  legislative 
procedure,  a strong  advocate  of  our 
total  political  system  and  she  was  a 
friend  to  all,  not  just  to  her  employer. 
She  was  particularly  loyal  to  medi- 
cine, and  I can  see  why  when  I look 
back  through  the  CMS  archives  and 
discover  the  impact  that  Carol's 
family  had  on  medicine. 


Carol's  father,  George  Byron 
Packard,  Jr.,  was  described  in  various 
CMS  publications  as  "one  of  the  truly 
great  men  of  our  medical  commu- 
nity. Dr.  Packard,  Emeritus  Professor 
of  Surgery,  held  the  Chairmanship  of 
the  Department  of  Surgery  at  the 
University  of  Colorado  from  1941  to 
1 947.  The  appointment  culminated 
many  years  of  teaching  and  research 
which  commenced  with  the  comple- 
tion of  his  surgical  training  at 
Massachusetts  General  Hospital  in 
Boston,  in  I 91  7." 

Dr.  Packard's  father,  George  B. 
Packard,  Sr.,  was  also  a Denver 
surgeon,  and  Carol's  uncle,  Robert 
G.  Packard,  was  an  orthopedic 
surgeon,  one  of  the  founders  of  the 
Rocky  Mountain  Orthopaedic 
Society.  I think  you  can  sample  the 
flavor  of  Carol  Tempest's  medical 
background. 

Carol  came  to  CMS  during  the 
reorganization  of  the  society  in  the 
administrations  of  Presidents,  Drs. 
William  Curtis  and  Robert  Sawyer.  It 
was,  in  great  part,  the  result  of 
reorganization  headed  by  Mr.  Larry 
Wells,  who  was  then  advising  both 
the  Denver  and  Colorado  Medical 
Society  on  association  structure  and 
created  the  Department  of  Govern- 
ment Affairs. 

Carol  will  be  greatly  missed  by 
all,  but  her  presence  will  be  felt 
forever.  Another  reminder  that  even 
the  most  durable  and  influential 
persons  can  pass  from  our  lives  so 
quickly. 


170 


Colorado  Medicine  for  May,  1993 


by  Roger  C.  Shenkel,  M.D.,  Family  Physician 
Secretary  Treasurer,  Mesa  County  Physicians  I.P.A. 
Grand  Junction,  Colorado 


Guest 


What  kind  of  chumps  do  insurance  companies  think  we  are? 


When  the  business  community 
decided  that  contract  medicine 
would  solve  most  problems,  the 
insurance  industry  put  together  a 
marketing  strategy  to  get  doctors  to 
sign  contracts.  They  used  some 
bizarre  assumptions: 

1 ) Doctors  are  easily  flattered. 

2)  Doctors  aim  to  please. 

3)  The  three  vulnerable  physi- 
cian personality  traits  are  greed,  fear, 
and  poor  business  judgment. 

So  they  came  after  us,  and  we 
signed  contracts  like  crazy.  Here's 
what  they  told  us: 

We  were  such  wonderful 
practitioners  that  we  were  the  only 
group  in  town  they  wanted  to  sign 
up  (flattery). 

If  we  didn't  sign  up,  our  patients 
would  disappear  (fear). 

Sf  we  did  sign  up,  we  might 
make  a little  more  money  than  we 
were  making  before  (greed). 

We  didn't  need  to  read  the  entire 
contract,  because  the  fee  schedule 
was  great  (greed  & poor  business 
judgment). 

We  should  help  them  out 
because  they  bought  us  lunch  and 
came  all  the  way  from  Denver  (aim 
to  please,  poor  business  judgment). 

Maybe,  the  insurance  company 
marketing  people  said,  we  could  get 
doctors  to  agree  to  reduced  fees, 
and,  in  return  they  will  allow  us  to 
use  their  names  and  reputations  to 
market  our  product  to  the  public. 
Sure  enough,  it  worked  (poor 
business  sense). 

If  we  scare  the  doctors  enough, 
they  will  be  pleased  not  to  get  fee 
reductions  - and  never  again  worry 


about  those  old-fashioned  annual  fee  | 
increases  (fear,  poor  business  sense). 

Did  the  insurance  industry 
succeed?  Yes,  and  beyond  their 
wildest  dreams.  Their  assumptions 
were  correct.  Physicians  were  naive 
and  poorly  organized. 

We  signed  contract  after  contract 
and  helped  to  create  a monster. 

When  we  signed  one  contract,  our 
ex-friends  signed  two,  and  the 
insurance  companies  loved  it.  Now 
we  are  sleeping  in  the  bed  we 
helped  make.  We  are  angry  at  each 
other,  and  our  patients  change 
doctors  every  other  January. 

How  far  will  we  let  them  push 
us?  When  will  our  leadership  speak 
out  and  unite  us  to  stand  firm  against 
this  system  that  benefits  no  one 
outside  the  insurance  industry?  Can 
we  afford  to  wait  for  the  government 
to  get  them  off  our  backs?  How  long 
will  we  continue  to  endorse  them 
with  our  participation?  When  the 
government  takes  over,  the  insurance 
companies  will  use  those  same 
participation  lists  to  convince  the 
Feds  that  they  have  the  best  insur- 
ance product  - the  one  the  govern- 
ment should  use. 

There  must  be  a limit,  and  I 
would  contend  that  the  time  has 
come  for  physicians  to  stand  up  and 
be  counted.  The  insurance  industry 
does  not  have  the  medical  interests 
of  our  patients  anywhere  on  their 
agenda.  We  must  be  the  moral 
conscience  for  the  future  of  medicine 
in  this  state  and  country,  and  it  must 
take  precedent  over  our  intra- 
professional financial  squabbles. 


How  long  will  we 
continue  to  endorse  them 
with  our  participation? 


We  and  the  I.P.A.'s  that  contract 
for  us  must  refuse  to  deal  with 
insurance  companies  that  have  no 
scruples  — companies  that  skim 
healthy  patients,  take  on  large  groups 
only,  deny  claims  inappropriately, 
apply  inappropriate  pressure  on 
providers,  and  refuse  to  address 
community  needs  — must  be 
dropped  regardless  of  the  financial 
repercussions.  We  may  offer  to  let 
them  change,  but  we  must  be  firm. 

To  acquiesce  to  the  status  quo  may 
gain  for  us  the  worst  possible 
insurance  partners  in  the  future. 

Who  will  administer  Medicaid? 
No  managed  care  plan  will  take  it  on 
unless  the  consequences  of  non- 
participation are  that  they  lose  their 
physician  provider  panel.  If  insur- 
ance companies  are  unwilling  to  pay 
the  price  of  participation,  let  them 
leave  the  game. 

We  have  been  pushed  far 
enough.  The  time  is  here  to  show 
them  our  limits. 


Colorado  Medicine  for  May,  1993 


171 


Some  day  in  May 


Last  March  I wrote  a letter 
to  Hillary  Rodham  Clinton 
suggesting  a way  her 
health  task  force  might 
save  a lot  of  money  for 
Medicare. . . 


I wrote  it  mostly  for  my  own 
satisfaction  because  I knew  she'd 
never  see  it.  Out  of  curiosity  I called 
a friend  at  the  AMA  to  ask  if  some 
special  address  would  give  any  letter 
a chance  of  actually  appearing  in 
front  of  the  First  Lady.  My  friend  said 
that  of  course  Mrs.  Clinton  was  not 
talking  to  the  AMA,  so  he  had  no 
passwords.  I mailed  the  letter 
anyway. 

So  Mrs.  Clinton's  secretive  task 
force  marches  toward  May,  insulated 
from  my  help,  and  that's  what 
concerns  us  practicing  doctors. 

We're  not  represented.  The  planners 
consider  that  we  have  "conflicts  of 
interest".  Even  our  patients  are  shut 
out.  The  closest  we  can  get  to  the 
sessions  is  in  the  ruminations  of  the 
excluded  media  and  one  list  of 
possible  plans  leaked  to  the  Wall 
Street  Journal.  We  already  know  that 
the  Clintons  think  the  doctors  and 
the  drug  companies  "charge  too 
much".  They  don't  seem  to  think  the 
tobacco  industry,  with  help  from 
government  money,  charges  too 
much  to  ruin  the  health  of  Ameri- 
cans. Can  we  hope  for  less  interfer- 
ence while  we  try  to  protect  it? 

I am  hopeful  but  cynical  that  the 
experts  in  the  wilderness  of  managed 
care,  managed  competition,  single 
payer  plans,  the  social  climates  of 
Canada,  Sweden,  and  the  United 
Kingdom  can  present  a plan  of  relief 
for  medical  care  that  will  be  suitably 
American.  I am  afraid  the  success  of 
new  plans  will  be  smothered  by  new 
and  expensive  bureaucracies  built  to 
administer  them.  Some  clamp  must 
be  squeezed  onto  the  Medicaid 
hemorrhage  now  draining  state 
budgets. 


by  Thomas  H.  Coleman , M.D. 

Internal  Medicine 
Denver,  Colorado 


Some  day  in  May  the  task  force 
will  weld  its  deliberations  into  one 
shape  and  roll  it  into  the  light.  We 
hope  it  will  not  come  out  brandish- 
ing price  controls,  fee  slashes  for 
primary  care  physicians,  more  forms 
for  us  to  fill  out,  or  straightjackets  for 
patients  against  free  choice  of 
physicians.  We  hope  it  will  proclaim 
a degree  of  universal  health  insur- 
ance independent  of  employment, 
with  part  of  the  premiums  tax- 
exempt.  There  must  be  some  shift  in 
spending  toward  the  beginnings  of 
life  and  away  from  its  long  and 
miserable  endings,  and  some 
freshness  in  the  FDA  to  encourage 
new  technical  ways  of  diagnosis  and 
treatment.  We  hope  it  will  not 
obstruct  the  personal  right  of  patients 
and  their  doctors  to  contract  freely. 
We  hope  the  computerized  machin- 
ery of  any  plan  will  not  mail  out 
suspicions  and  threats  to  doctors  and 
patients  while  they  are  trying  to 
enjoy  good  professional  care.  We 
hope  it  will  offer  equitable  fee 
schedules  free  of  complex  and 
arbitrary  formulas,  with  incentives 
for  all  doctors.  There  must  be  special 
encouragement  for  medical  students 
to  become  primary  care  physicians. 

Most  avowed  goals  of  the 
Clinton  project  are  admirable.  I 
wouldn't  expect  that  anyone, 
including  the  accomplished  and 
intelligent  Mrs.  Clinton  and  her  cast 
of  500,  could  achieve  all  of  them, 
especially  not  in  three  months,  but  if 
they  are  conceived  in  a spirit  of 
consideration  for  the  nation's  doctors 
they  will  have  a better  chance  of 
success  in  the  years  ahead.  For  now 
we  can  only  be  fascinated  waiting  to 
see  how  much  money  it  will  cost  to 
give  up  how  many  freedoms. 


172 


Colorado  Medicine  for  May,  1993 


Invitation  to  CMS  Leadership  Conference 


by  William  Carl  Bailey , MD 
President  Elect 


Doctors  are  doing  a great  deal 
of  dithering  these  days  about  the 
prospect  of  the  Clinton  Health  Care 
Plan.  Sometimes  it  is  hard  to  remem- 
ber that  "The  Plan"  is  not  going  to 
originate  de  novo,  but  rather  as  a 
product  of  poiitical/social  engineer- 
ing in  response  to  a vast  array  of 
economic,  social,  and  technological 
factors  which  have  been  building  up 
over  the  past  many  years.  Sen.  John 
D.  Rockefeller  IV  (D-WVa)  has 
referred  to  the  coming  health-care 
revolution  as  "the  largest  undertaking 
in  our  social  history".  We  have  been 
witness  to  the  unfolding  of  the 
drama,  but  unwilling  to  acknowl- 
edge and  accept  it.  At  the  same  time, 
we  should  be  recognizing  that 
periods  of  revolution  offer  great 
opportunity  to  those  who  are  willing 
to  risk  and  to  work  (we  are  con- 
sumed with  fear).  Nor  is  it  fair  to 
deny  that  there  are  threats  out  there. 
Medical  practice  in  this  country  will 
never  be  the  same.  We  are  assured 
that  we  are  going  to  see  physicians 
marginally  employed  or  out  of  work, 
that  there  will  be  threats  to  profes- 
sional autonomy,  and  that  our 
relationships  to  hospitals  and 
colleagues  will  change.  Yet,  we  must 
not  let  anxiety  and  unwillingness  to 
face  reality  paralyze  us,  and  thus 
assure  self-fulfilling  prophecy.  To 
paraphrase  what  one  of  our  members 
recently  said,  "behold  the  ostrich 
with  his  head  buried  in  the  sand  — 
you  don't  need  to  be  a rocket 
scientist  to  figure  out  where  he's 
going  to  be  shot!" 

Writing  elsewhere  in  this  issue, 
Roger  Shenkel  eloquently  voices  the 
concern  and  frustration  being 


experienced  by  many  of  us.  He 
correctly  concludes  that  the  Medical 
Society  and  its  leadership  must 
provide  direction,  and  together  we 
must  seek  solutions.  I want  to 
expand  on  his  plea  and  invite  all  of 
you  who  are  ready  to  take  a proac- 
tive stance  to  join  us  in  the  1993 
Leadership  Conference  July  17-18  in 
Fort  Collins.  The  CMS  membership 
needs  to  speak  out  on  health  care 
forthrightly  to  serve  our  patients  and 
to  preserve  the  ethical  ideals  of  our 
profession.  We  must  set  aside  daily 
cares  and  the  preoccupations  which 
weigh  us  down  to  meet  and  pool  our 
collective  resources  to  address  these 
public  issues,  and  to  position  the 
CMS  to  effectively  respond  as  the 
voice  of  Colorado  physicians.  This  is 
a time  for  courage  and  action.  Plan 
to  attend  the  1993  Leadership 
Conference  to  help  set  the  course 
and  bring  new  power  and  effective- 
ness to  our  organization.  Carpe 
diem! 


"behold  the  ostrich  with 
his  head  buried  in  the 
sand  — you  don't  need  to 
be  a rocket  scientist  to 
figure  out  where  he's 
going  to  be  shot!" 


Colorado  Medicine  for  May,  1993 


173 


MEETING:  AMA  "A  Time  For  New  Partnership" 

Washington,  D.C.  • March  23-25,  1992 

SUBJECT: 

Health  Care  Reform 

SPEAKERS: 

A dministra  tion : 

Vice  President  Al  Gore  (substitute  for  Ms.  Hillary  R.  Clinton) 

Donna  Shalala 

Dr.  Jim  Todd,  EVP,  AMA 

Democrat:  Republican: 

Pete  Stark,  CA  Phil  Gramm,  TX 

Edward  Kennedy,  MA  Robert  Dole,  KS 

John  D.  Rockefeller,  WV  Newt  Gingrich,  GA 

George  Mitchell,  ME  Don  Nickles,  OK  i 

REPORTER: 

Frederick  A.  Lewis  Jr.,  M.D,.  Denver,  Colorado 

Editor's  Note:  The  American  Medical  Association  reported  to  its  members  that  the  March  meeting  in  Washington,  D.  C.  (AMA- 
sponsored  meeting  of  AMA  membership  and  Clinton  Administration  officials  on  health  care  reform  entitled  "A  Time  for  New 
Partnership")  was  "a  resounding  success".  The  AMA  report  went  on  to  say  that  "the  event  attracted  national  media  attention, 
as  well  as  local  TV coverage".  Colorado  Medicine  asked  former  CMS  President  Frederick  A.  Lewis  Jr,  M.D.,  togiveus  his  views 
on  the  meeting,  not  as  a CMS  representative,  but  as  a physician  attending  a Washington,  D.C.,  "event".  Following  is  a no- 
nonsense  report  by  a physician,  the  first  one  we've  received. 


General  Observations: 

• Absolutely  no  details  were 
provided  in  regard  to  the  admin- 
istration's health  care  reform  pro- 
posal. 

• The  Republicans  have  had  no 
input  into  the  planning  process  and 
are  angry. 

• The  Democrats  on  the  hill  have 
very  little  input  and  key  figures  such 
as  Stark,  Rostenkowski,  and  Kennedy 
are  unhappy. 

• The  AMA  and  traditional  lobby- 
ing groups  have  had  no  input.  It  is 
said  that  there  are  physicians  in- 
volved in  the  500  person  planning 
group  but  no  one  is  able  to  identify 
one  physician  who  is  primarily 
involved  in  patient  care. 

• Democratic  strategy  is  to  intro- 
duce the  bill,  hold  hearings,  and  do 
their  best  to  insure  that  everyone  in 
the  country  understands  it  thor- 
oughly. 

• This  is  the  key  issue  in  terms  of 
whether  or  not  a bill  is  passed  this 
year.  Jay  Rockefeller,  a strong 
supporter  of  the  administration's 
proposal,  remarked  that  if  the  bill  did 
not  pass  this  year,  it  probably  would 

174 


not  pass.  (1994  is  an  election  year.) 

• Almost  all  of  the  talk  on  the  Hill 
has  to  do  with  cost  control  with 
minimal  lip  service  being  paid  to 
access  and  quality. 

• Short  term  administration 
strategy  - fee  freeze  or  cost  controls. 
(Mandated  universal  use  of  RBRVS 
with  no  balance  billing.) 

• Long  term  administration 
strategy  - global  budgets. 

• Current  AMA  strategy  - willing  to 
negotiate  "predictable  health  care 
costs". 

• AMA  has  a real  problem.  Jim 
Todd  and  his  troops  cannot  com- 
plain too  loudly  about  being  left  out 
without  sending  a message  to  the 
rank  and  file  that  they  are  ineffectual. 

• "Carrots"  to  physicians  to  go 
along  with  the  Clinton  proposal: 

1 . Less  bureaucratic  hassle  - 
uniform  billing,  uniform  review 
criteria,  etc. 

2.  Malpractice  reform. 

3.  Anti-trust  relief. 

• All  of  the  legislators  on  both 
sides  of  the  aisle  emphasized 
repeatedly  the  necessity  for  physi- 
cian input  and  support  in  order  to 
implement  any  health  care  reform 


system. 

• The  administration's  response 
was  to  schedule  an  open  hearing  for 
March  29  and  to  give  each  provider 
group  three  minutes  to  testify. 

• All  of  the  legislators  mentioned 
the  1989  debacle  in  which  Congress 
passed  catastrophic  insurance  for  the 
elderly,  to  be  paid  for  by  elderly 
beneficiaries.  The  bill  passed  in  an 
overwhelming  bipartisan  fashion 
only  to  be  bitterly  criticized  by  the 
elderly  and  repealed  the  following 
year. 

• Congress  seems  genuinely 
apprehensive  about  making  a 
mistake. 

• Everyone,  including  the  AMA, 
agreed  that  the  current  system  was 
"broke"  and  should  be  fixed.  How- 
ever, the  Republicans  pointed  out, 
over  and  over,  that  we  should  be 
careful  that  we  don't  wind  up 
"paying  more  for  less". 

• Almost  everyone  agreed  that  the 
nation's  economic  future  is  depen- 
dent on  solving  the  problem  of 
escalating  health  care  costs. 

• There  was  a good  deal  of 
concern  expressed  by  the  Republi- 
cans that  health  care  reform  should 


Colorado  Medicine  for  May,  1993 


not  place  a burden  on  small  business 
and  thus  slow  the  nation's  economic 
recovery. 

• There  was  some  support  for 
folding  Medicaid  into  Medicare  with 
the  use  of  vouchers  for  the  uninsured 
and  underinsured  and  wholesale 
institution  of  price  controls  on  the 
entire  health  care  system.  The 
perception  is  that  this  would  prevent 
cost  shifting  and  stabilize  costs.  The 
expansion  could  be  financed,  at  least 
in  part,  by  the  elimination  of  medical 
deductions  by  both  employers  and 
employees.  (This  was  not  suggested 
by  the  administration  but  did  come 
from  both  sides  of  the  Congressional 
aisle.) 

Specific  Speakers 

NOTE:  More  space  has  been  devoted 
to  Democratic  comments  since, 
realistically,  their  views  will  have 
more  impact  on  the  final  shape  of 
the  legislative  package. 

• Pete  Stark  - not  a friend  of 
medicine  but,  almost  alone,  was 
honest  about  the  potential  impact  on 
physicians.  He  pointed  out  that,  in 
managed  competition,  there  would 
be  winners  and  losers.  He  speculated 
that  some  of  the  big  losers  would  be 
physician  groups  who  compete  with 
lower  priced  providers  - such  as 
primary  care  docs,  ophthalmologists, 
orthopedic  surgeons,  psychiatrists, 
etc.  He  also  said  that  managed 
competition  would  put  an  end  to  the 
independent  practice  of  medicine.  In 
terms  of  immediate  cost  contain- 
ment, Stark  said  there  were  three 
choices  - Fee  Freeze  which  did  not 
work  well  in  70's  plus  fact  that  in 


1993  most  physicians  have  multiple 
fees  for  the  same  procedure  and 
there  is  no  way  to  know  which  fee 
should  be  frozen  - Cost  Controls  - 
use  DRG's  and  RBRVS  throughout 
health  care  system  - or  Freeze  on 
insurance  Premiums  - leave  it  to 
insurance  companies  to  figure  out 
how  to  put  a sufficient  number  of 
obstacles  in  the  path  of  reimburse- 
ment so  that  overall  costs  are 
decreased.  (Generally  this  seems  to 
be  what  is  happening  in  the  private 
sector  at  the  present  time.)  Stark 
favors  cost  controls  and  also  pointed 
out  the  critical  importance  of  the 
benefit  package.  "Total  access  is  fine 
but  total  access  to  what?  If  the 
benefit  system  is  too  modest  it  will 
inevitably  lead  to  a two  tier  system." 

• Ted  Kennedy  - having  heard  him 
many  times  before,  it  seemed 
apparent  that  he  was  bored.  He  read 
a short  speech  in  a perfunctory 
manner  and  did  not  seem  knowl- 
edgeable or  involved  until  he  began 
answering  questions.  It  seems  likely 
that  he  feels  "left  out". 

• Donna  Shalala  - read  a short 
speech  written  by  her  staff  for  a 
different  audience.  Left  immediately, 
did  not  answer  questions.  At  one 
point,  said  that  75%  of  cases  of 
psoriasis  were  caused  by  alcoholism. 
It  would  have  been  more  polite  if  she 
had  simply  not  come. 

• Al  Gore  - promised  that  patients 
would  have  free  choice  of  "insur- 
ance system"  and  "free  choice  of 
physician".  (He  either  does  not 
understand  what  these  phrases 
mean,  is  naive,  or  deceptive.) 


• Bob  Dole  - brought  a large 
picture  of  the  White  House  with  him, 
saying  that  he  wanted  to  make 
certain  that  the  AMA  at  least  knew 
what  it  looked  like  from  the  outside. 

• George  Mitchell  - Thoughtful 
but  general,  pointed  out  the  financial 
problems  inherent  in  having  a 
predominance  of  specialty  over 
primary  care  physicians,  the  need  for 
outcome  research,  and  the  fact  that 
health  care  is  being  rationed  now  - 
"we  just  need  to  make  certain  that 
the  rationing  is  clone  on  a rational 
basis". 

• Jay  Rockefeller  - a strong, 
persuasive  advocate  for  the  Admin- 
istration's proposal  (whatever  it 
might  turn  out  to  be).  Said  that  this 
was  the  single  most  difficult,  compli- 
cated, social  policy  decision  ever 
made  in  the  world.  He  suggested  that 
there  were  only  three  alternatives: 

1 . Perpetuation  of  the  status  quo 
which  is  growing  worse  and 
bogging  down  our  economy. 

2.  Single  payor  system. 

3.  Clinton's  program. 

He  suggested  that,  in  addition  to 
the  future  of  health  care,  we  were 
dealing  with  economic  reform,  the 
political  future  of  Clinton  and  his 
administration,  the  economic  future 
of  our  country  and,  ultimately,  our 
national  survival.  He  stated  that, 
under  Clinton's  plan: 

A.  Patients  will  benefit  by  having  to- 
tal access  to  affordable,  quality 
health  care  which  will  be  portable 
(from  one  job  to  another),  com- 
munity rated,  and  have  no  exclu- 
sions for  preexisting  conditions. 

(Continued) 


Colorado  Medicine  for  May,  1993 


175 


B.  Physicians  will  benefit  because  of  universal  coverage,  no  uncompensated 
care,  decreased  paper  work,  malpractice  reform,  and  repeal  of  anti-trust 
legislation. 

C.  Business  will  benefit  because  of  the  elimination  of  cost  shifting  and  the 
institution  of  predictable  health  care  costs. 

• Newt  Gingrich  - undoubtedly  the  star  speaker  of  the  meeting.  The  last 
speaker,  followed  by  standing  applause.  Among  other  things,  said  "This  is  a 
secret  plan,  designed  in  secret,  by  secret  people  and  presented  as  a 'plan  you 
can  trust'".  He  made  a plea  for  administration  honesty  and  openness,  saying, 
for  example,  "You  can't  have  global  budgeting  without  rationing."  He  also 
said  "This  is  not  about  health,  not  about  doctors  or  hospitals  - it's  about  your 
country  and  it's  future.  It  is  an  effort  to  socialize  14%  of  the  nation's  eco- 
nomy." It  was  a fun  speech  and  I would  urge  you  to  listen  to  it  if  you  have 
the  opportunity. 

• Jim  Todd  - at  the  conclusion  of  the  day,  Todd  said  that  he  had  heard  the 
"quid  pro  quo"  - a decrease  in  bureaucracy  and  malpractice  reform  in 
exchange  for  price  controls  and  global  budgets.  He  said  "no  thanks"  but 
added  that  the  AMA  would  be  willing  to  discuss  and  negotiate  anything. 


Overall  Conclusions 

• As  of  3/24/93  no  one  outside  of  Clinton's  health  policy  team  (and 
perhaps  within  the  team)  has  a clear  conception  of  the  details  of  the 
administration's  health  care  reform  legislation,  to  be  introduced  in 
early  May.  No  one  really  knows  what  managed  competition  means 
to  the  Clinton  administration. 

• The  chances  of  passage  are  dependent  on  Clinton  being  able  to 
stampede  Congress  by  persuading  Members  that  people  are  de- 
manding a change. 

• A persual  of  the  media  would  suggest  that  this  PR  campaign  has 
already  begun. 

• All  of  the  Republicans  and  many  of  the  influential  Democrats  with 
past  expertise  in  health  care  have  been  excluded  from  the  process, 
are  not  happy,  and  will  not  be  easily  stampeded.  Delay  decreases 
the  chances  of  passage  of  true  health  care  reform. 

• Cost  controls  on  doctors,  hospitals,  and  drugs  are  quite  likely  this 
year  as  are  global  budgets.  All  of  these  actions  can  be  taken  without 
restructuring  the  health  care  delivery  system. 

• In  addition  to  cost  controls,  there  may  be  an  effort  to  fold  Medicaid 
into  Medicare,  provide  for  total  access,  and  pay  for  it  by  elimination 
of  all  deductions  for  medical  expenses. 


You  didn’t 
spend 
umpteen 
years  in 
school  in 
order  to 
become  a 

bill 

collector. 

Collecting  money  from 
slow  paying  patients  is  critical 
to  your  practice.  But  you  didn’t 
spend  all  those  years  in  school 
to  become  a bill  collector. 

And  that’s  where  I.C. 
System  can  help. 

First  of  all,  we  have  the 
resources  and  expertise  to  do 
the  job.  And  while  we’re 
tenacious,  we  treat  your 
delinquent  patients  with 
courtesy  and  respect. 

In  fact,  our  work  is  en- 
dorsed by  over  1,200  profes- 
sional associations  and  societ- 
ies, including  the  Colorado 
Medical  Society.  And  no 
matter  where  you’re  located  or 
where  your  debtors  live,  we 
have  local  representatives  to 
service  your  account. 

But  most  important,  we 
guarantee  results,  by  collect- 
ing at  least  ten  times  the 
amount  of  our  retainer. 

To  find  how  the  I.C. 

System  approach  can  work  for 
you,  call  toll  free  (800)  824- 
9469,  ext.  330. 


fftl.C.  System 

The  System  J Works. 


176 


Colorado  Medicine  for  May,  1993 


HEALTH  INSURANCE  QUIZ 

In  recent  months,  the  State  Insurance  Commisisoner  has  been  gathering  data  about  Colorado  health  care  as  the 
legislature  awaits  results  of  a health  insurance  study  funded  by  the  Robert  Wood  Johnson  Foundation.  This  study  was 
authorized  under  1992  health  care  reform  legislation  concerning  ColoradoCare. 

Insurance  Commissioner  Jo  Ann  Hill  recently  published  a quiz  for  all  those  interested  parties  to  the  discussion.  Test 
yourself  and  see  how  your  answers  compare  to  the  Commissioner's.  Her  answers  appear  below. 

1 HOW  MANY  PEOPLE  IN  COLORADO  HAVE  NEITHER  PRIVATE  NOR  PUBLIC  HEALTH  INSURANCE? 

(a)  100,000  (b)  225,000  (c)  514,000  (d)  1 ,000,000 

2 WHO  ARE  THE  MOST  LIKELY  TO  BE  UNINSURED? 

(a)  The  elderly  (b)  The  working  poor  (c)  Newborn  babies  (d)  Smokers 

3 THE  LARGEST  PROPORTION  OF  UNINSURED  ADULTS  (34%)  WORK: 

(a)  Part-time  (b)  Full-time,  part-year  (c)  Full-time,  full-year  (d)  Not  in  labor  force 

4 COLORADO  FIRMS  WITH  LESS  THAN  25  EMPLOYEES  ACCOUNT  FOR  30%  OF  ALL  EMPLOYMENT  IN  THE 
STATE.  COLORADO  SMALL  FIRMS  ACCOUNT  FOR  WHAT  PERCENT  OF  UNINSURED  WORKING  ADULTS? 

(a)  62%  (b)  48%  (c)  40%  (d)  35% 

5 BUSINESS  HEALTH  INSURANCE  COSTS  HAVE  INCREASED  AN  AVERAGE  OF  HOW  MUCH  EVERY  YEAR 
FOR  EACH  OF  THE  PAST  FOUR  YEARS? 

(a)  8-10%  (b)  11-15%  (c)  16-20%  (d)  21-25% 

6 IN  1986,  73%  OF  COLORADO  SMALL  BUSINESSES  OFFERED  HEALTH  INSURANCE  TO  THEIR  EMPLOYEES. 
BY  1989,  WHAT  PERCENT  OF  SMALL  BUSINESSES  OFFERED  HEALTH  INSURANCE? 

(a)  75%  (b)  80%  (c)  21-25%  (d)  63% 

7.  PRIVATE  HEALTH  INSURANCE  CONSUMES  HOW  MANY  CENTS  OF  EVERY  HEALTH  CARE  DOLLAR  SPENT 
IN  COLORADO? 

(a)  33tf  (b)  7 5<t  (c)  83tf  (d)  63tf 

8 MORE  THAN  HALF  OF  COLORADO  RESIDENTS  SURVEYED  BY  LOUIS  HARRIS  AND  ASSOCIATES  IN  1988 
SUPPORTED  WHICH  OF  THE  FOLLOWING  STATEMENTS? 

(a)  I would  support  national  health  insurance  which  would  replace  Medicare,  Medicaid  and  all  private 
insurance  with  a system  for  everybody. 

(b)  Everybody  should  have  the  right  to  see  a doctor  and  be  admitted  to  the  hospital  as  needed. 

(c)  I would  support  a new  law  which  would  require  all  employers  including  small  business  to  provide  their 
employees  with  a basic  minimum  level  of  health  insurance. 

(d)  There  are  some  good  things  in  our  health  care  system,  but  fundamental  changes  are  needed  to  make  it 
work  better. 


(q)-8  '(e)-z  '(p)-9  'G>)-s  '(q)-t>  'pk  '(q)-z  'P)-l 

isja/wsuy 


Colorado  Medicine  for  May,  1993 


177 


Physician  Profile 


Jim  Parker,  M.D.,  Grand  Junction,  Colorado 


Reprinted  with  permission  of  Rocky  Mountain  HMO 


I was  born , as  they  say 
at  a very  early  age  in  the 
high  mountain  country  of 
Colorado. 

I'm  not  sure  if  it  was  a 
dark  and  stormy  night , 
but  April  in  Telluride  is 
seldom  pleasant. 


I was  attended  in  birth  by  my 
father,  Dr.  Joe  Parker  and  Dr. 

Norman  Brethhower  of  Montrose. 
Unencumbered  by  fetai  monitors, 
internal  pressure  gauges,  ultrasound 
determinations,  or  legal  supervisions, 
my  mother  was  able  to  bring  me 
forth  after  only  3 days  of  labor. 

I know  it  was  3 days  because 
during  my  childhood,  minor  and 
major  inconsistencies  in  my  social  or 
academic  performance  would  elicit  a 
review  of  the  entire  labor.  Perhaps  if 
a timely  C-section  had  been  done,  I 
might  have  grown  up  to  be  the  Vice 
President. 

Having  recently  read,  "All  1 Ever 
Really  Needed  To  Know  I Learned  in 
Kindergarten."  I appreciate  the 
etiology  of  my  psyche,  social  and 
personal  problems.  In  1939,  there 
was  no  Kindergarten  in  Telluride. 

People  remind  me  of  how 
wonderful  it  must  have  been  to  have 
grown  up  in  such  a beautiful  envi- 
ronment. Beautiful?  Who  is  to  know 
the  difference?  As  my  father  was  the 
only  physician  in  San  Miguel 
County,  we  literally  never  went 
anywhere.  Our  only  vacation  was  in 
1939  when  a fuzzy-cheeked  (he  still 
is)  junior  medical  student  named  G. 
Paul  Smith  did  a 3 month  externship 
in  Telluride.  He  covered  the  practice 
for  two  weeks  and  we  took  a trip  to 
California.  Unfortunately,  Disney- 
land had  not  yet  been  invented.  It 
was  only  after  returning  to  Telluride 
that  I was  finally  able  to  appreciate 
the  region's  natural  beauty. 

An  interest  in  medicine  came 
when  I made  house  calls  with  my 
father  and  would  watch  surgical 
procedures.  I must  have  been 
motivated.  Watching  a T&A  done 


under  local,  with  the  patient  sitting 
in  a chair,  is  a bit  awesome  to  a pre- 
teen.  For  other  surgical  procedures, 
he  used  a spinal  anesthetic,  where 
my  mother  (an  R.N.)  gave  ether 
anesthetics.  I was  probably  six  years 
old  before  I realized  that  all  child- 
ren's mother's  breath  did  not  smell 
like  ether  fumes. 

At  fourteen,  I would  give  drop 
ether  - a safety  pin  stuck  through  the 
lip  of  an  ether  can  - and  drop  by 
drop  the  ether  was  layered  over  a 
folded  gauze  supported  by  a metal 
ribbed  mask  over  the  patient's  face. 
These  were  for  minor  procedures, 
debriding  injuries,  setting  fractures 
and  so  forth. 

After  the  war,  government 
subsidies  on  lead  and  zinc  dropped. 
As  miners  were  laid  off,  so  did  my 
father's  income,  as  he  had  one  of  the 
first  "HMO"  contracts  written  in 
Colorado.  The  contract  called  for  the 
mine  to  collect  $ 1 .50  per  month  for 
employees  and  $2.25  per  month  for 
employees  with  dependents.  For  this 
the  physician  was  to  provide  "com- 
modius  and  sanitary  hospital  at  and 
within  the  city  of  Telluride,  properly 
equipped  for  the  use  and  care  of 
patients."  Specifically  excluded  from 
the  agreements  were  "all  obstetrical 
cases  ($25)  and  the  treatment  of 
VD." 

After  high  school,  I started 
college  at  the  University  of  Colorado 
in  Boulder.  After  my  father  found  out 
that  the  "3.2"  I was  referring  to  was 
my  blood  level  and  not  my  GPA,  I 
transferred  to  Western  State  College 
and  received  my  Bachelor's  degree.  I 
attended  graduate  school  in  Greeley 
for  a year  and,  as  an  alternate  to 
medical  school,  I worked  in  the 


178 


Colorado  Medicine  for  May,  1993 


physiology  department  for  a year  as 
a teaching  and  research  assistant. 

The  highlight  of  my  sophomore 
year  was  meeting  my  wife  Vicki,  a 
sophomore  in  the  school  of  nursing. 
We  both  worked  at  St.  Mary's  the 
next  summer.  I was  a Scrub  Tech  in 
the  OR  and  she  was  a student  nurse. 
Married  a year  later,  we  went  to 
Dartmouth  Hitchcock  Hospital  in 
Hanover,  New  Hampshire  for 
internship  and  Vicki's  first  nursing 
job. 

Unsure  as  to  specialty  orienta- 
tion, I considered  a surgery  resi- 
dency, accepted  and  declined  a OB/ 
GYN  residency,  and  finally  (with  the 
help  of  Seymour  Wheelock,  M.D.), 
we  returned  to  Colorado  to  a resi- 
dency at  Denver  Children's  Hospital. 

After  visiting  Grand  junction  and 
attending  a Chamber  of  Commerce 
dinner  with  my  folks,  we  were 
convinced  to  return.  A town  of  older 
people  when  I left  for  college,  Grand 
Junction  was  now  a busy  and  active 
town.  There  had  either  been  an 
influx  of  younger  people  or  I was  a 


lot  older.  We  saw  an  exciting, 
progressive  town,  and  elected  to 
come  back  and  do  family  practice. 
Accompanied  by  three  month  old 
Kevin,  we  joined  my  father  in 
practice. 

After  3 1/2  years  of  a very  busy 
practice,  I was  drafted  into  the  U.S. 
Army  Medical  Corp.  I received  no 
serious  injuries,  and  was  awarded  no 
medals  during  this  conflict  - prob- 
ably because  the  closest  I got  to 
Vietnam  was  Fort  Riley,  Kansas.  I 
was  assigned  to  the  pediatric  clinic, 
but  due  to  a shortage  of  Obstetri- 
cians, I was  on  OB  call  during  my 
second  year. 

Daughter  Karen  was  born  before 
I was  drafted,  and  Kristen  was  born 
on  the  4th  of  July  as  we  were 
reestablishing  our  practice  in  Grand 
Junction. 

I was  certified  as  a Fellow  of  the 
American  Academy  of  Family 
Practice  in  1975,  and  hope  to  be  in 
active  practice  for  many  more  years. 

I did,  however,  give  up  OB  on 


January  1,  1993.  My  father's  first 
deliveries  were  in  Tel  I u ride  in  1932, 
and  my  last  delivery  was  in  Decem- 
ber of  1 992  - Sixty  years  of  the 
prettiest  babies  in  the  nursery! 

My  wife  Vicki  is  still  at  work  on 
St.  Mary's  Telemetry  unit.  Our 
leisure  is  mainly  enjoying  the  great 
Colorado  outdoors,  spending  a lot  of 
time  with  our  horses. 

Son  Kevin,  28,  works  for  Mid- 
west Express  Airlines  in  Denver. 
Daughter  Karen,  27  is  a newborn 
Intensive  care  nurse  at  Denver 
Presbyterian  St.  Lukes  Hospital,  and 
Kristen,  22,  just  graduated  from  the 
University  of  Colorado. 

I have  found  that  practicing  in  St. 
Mary's  is  not  unlike  living  in  Tellu- 
ride.  You  have  to  see  life  elsewhere 
to  really  appreciate  the  beauty  of  our 
medical  community. 


Americans  At  Their  Best. 


Make  the  investment  that 
returns  more  than  money. 


Everything  can’t  be  measured  in  cash 
flow.  Camaraderie,  Pride,  Patriotism. 
All  special  feelings  that  take  on  new 
meaning  in  the  Army  National  Guard. 
It’s  a small  investment.  But  the  returns 
are  big.  And  they’re  not  all  intangible, 
either.  The  exposure  alone  can  help 
increase  your  patient  referral  base. 

As  a physician,  you  will  be 
appointed  as  a Captain  in  the  Guard, 
with  unlimited  potential  to  further  your 
rank.  'Ilie  challenge  is  there,  too.  As 
a member  of  the  states  Trauma  Team, 
you’ll  face  medical  situations  you  don’t 
normally  see  in  your  day-to-day 
practice. 

You  can  attend  national  medical 
conventions  fully  paid  for  by  us.  We 
give  you  the  opportunity  to  expand 
your  knowledge  of  other  fields  of 
medicine  with  Guard  sponsored 
educational  programs. 

We’ll  also  help  you  further  your 
formal  education.  The  Army  Guard 
provides  financial  assistance  for 


qualified  residency  programs,  as  well  as  outstanding 
educational  loans.  All  in  addition  to  generous  retirement 
benefits.  And  numerous  other  privileges.  If  you’re  between  the 
ages  of  21  and  47,  enrolled  or  graduate  from  an  accredited 
medical  school,  and  a U.S.  citizen,  contact  the  Army  National 
Guard  Medical  Recruiter.  2LT  JOHN  CLIFFORD 
( 303)  367-4397  or  1-800-762-4503 


Colorado  Medicine  for  May,  1993 


179 


Health  Care  Financing 

Billing  Medicare  for  Hospital  Initial  Observation  Care 

Edie  K.  Register,  Director 


If  you  have  any  questions  concerning  the  information  contained  in  this  article  please  contact  the  Medicare  Carrier  at 
(303)  831-  1221  or  contact  CMS  Health  Care  Financing  at  779-5455  or  1 -800-654-5653,  extension  421 . 


The  Colorado  Medical  Society 
(CMS)  has  received  clarification  from 
the  Medicare  Carrier,  Blue  Cross 
Blue  Shield  of  Colorado,  regarding 
the  use  of  Hospital  Initial  Observa- 
tion Care,  Current  Procedural 
Terminology  (CPT)  procedure  codes 
99218,  99219,  and  99220.  The 
following  information  addresses  a 
multitude  of  issues  related  to  care  in 
the  observation  area. 

As  indicated  in  the  1993  CPT 
book,  only  the  physician  admitting 
the  patient  to  the  hospital  observa- 
tion area  may  bill  the  hospital 
observation  code.  All  other  physi- 
cians seeing  the  patient  in  the 
observation  area,  must  bill  Medicare 
using  the  appropriate  office  and 
other  outpatient  visit  code  or  outpa- 
tient consultation  code. 

For  example,  If  an  internist 
admits  a patient  to  observation  and 
asks  an  allergist  for  a consultation  on 
the  patient's  condition,  only  the 
internist  may  bill  the  observation 
code.  The  allergist  would  bill  the 
appropriate  level  of  outpatient 
consultation.  The  inpatient  consulta- 
tion code  would  not  be  appropriate 
since  the  patient  was  not  a hospital 
inpatient. 

If  admission  and  discharge  from 
the  observation  occur  on  the  same 
day,  only  the  initial  care  code  may 
be  used.  If  the  patient  remains  in 
observation  after  midnight  following 
the  admission  and  the  patient  is 
discharged  on  the  second  calendar 
date,  the  physician  must  use  the 
discharge  day  management  code 
99238  to  bill  for  the  second  day. 

The  Carrier  has  revised  their  process- 
ing system  to  allow  an  outpatient 
place  of  service  to  be  used  with 
procedure  code  99238.  The  Health 
Care  Financing  Administration 
(HCFA)  Regional  Office  has  stated  in 
a recent  letter  to  the  Carrier.  "For  the 


rare  circumstance  when  a patient  is 
held  in  observation  status  for  more 
than  two  calendar  dates,  the  physi- 
cian must  bill  subsequent  daily  visits 
using  the  outpatient/office  visit 
codes.  The  physician  may  not  use 
the  subsequent  hospital  care  code 
since  the  patient  is  not  an  inpatient 
of  the  hospital." 

If  the  patient  is  admitted  to 
inpatient  status  from  the  observation 
area  on  the  same  date  as  admission 
to  the  observation  area,  the  physi- 
cian is  allowed  only  to  bill  for  the 
initial  hospital  visit.  If  the  patient  is 
admitted  to  inpatient  status  from 
observation  on  a subsequent  day,  the 
physician  may  bill  the  initial  obser- 
vation care  on  the  first  day  and  an 
initial  hospital  visit  on  the  subse- 
quent day.  A word  of  caution,  a 
lower  level  initial  hospital  visit 
would  normally  be  expected  be- 
cause HCFA  feels  the  majority  of 
work  associated  with  the  visit  would 
have  been  performed  at  the  admis- 
sion to  the  observation  area.  Dis- 
charge day  management  or  outpa- 
tient/office visit  for  the  care  provided 
in  observation  on  the  date  of  admis- 
sion to  inpatient  status  may  not  be 
billed  separately. 

The  global  surgical  fee  includes 
payment  for  hospital  observation 
(99218,  99219,  and  99220)  services 
unless  the  criteria  for  use  of  CPT 
modifiers  24,  25,  or  Ql  (decision  for 
major  surgery)  are  met. 

Example  of  the  decision  for  surgery 
duringa  hospital  observation  period  is: 
• A patient  is  admitted  by  a neurosurgeon 
to  a hospital  observation  unit  for  observa- 
tion of  a head  injury.  During  the  observa- 
tion period,  the  surgeon  makes  the  deci- 
sion for  surgery.  The  surgeon  would  bill  the 
appropriate  level  of  hospital  observation 
code  with  the  Ql  modifier  to  indicate  that 
the  decision  for  surgery  was  made  while 
the  surgeon  was  providing  hospital  obser- 
vation care. 


Examples  of  hospital  observation 
services  during  the  post-operative  pe- 
riod of  a surgery  are: 

• A patient  at  the  80th  day  following  a 
TURP  (transurethral  resection  of  prostate) 
is  admitted  to  observation  by  the  surgeon 
who  performed  the  procedure  with  ab- 
dominal pain  from  a kidney  stone.  The 
surgeon  decides  that  the  patient  does  not 
require  surgery.  The  surgeon  would  bill  the 
observation  code  with  CPT  modifier  24 
indicating  that  the  observation  services  were 
unrelated  to  the  surgery. 

• A patient  at  the  80th  day  following  a 
TURP  is  admitted  to  observation  with  ab- 
dominal pain  by  the  surgeon  who  per- 
formed the  procedure.  While  the  patient  is 
in  hospital  observation,  the  surgeon  de- 
cides that  the  patient  requires  kidney  sur- 
gery. The  surgeon  would  bill  the  observa- 
tion code  with  modifier  Ql  to  indicate  that 
the  decision  for  surgery  was  made  while 
the  patient  was  in  hospital  observation. 
The  subsequent  surgical  procedure  would 
be  reported  with  modifier  79  indicatingthe 
procedure  was  unrelated  to  the  original 
procedure. 

• A patient  at  the  20th  day  following  a 
resection  of  the  colon  is  admitted  to  obser- 
vation for  abdominal  pain  by  the  surgeon 
who  performed  the  surgery.  The  surgeon 
determines  that  the  patient  requires  no 
further  colon  surgery  and  discharges  the 
patient.  The  surgeon  may  not  bill  for  the 
observation  services  furnished  during  the 
global  period  because  they  were  related  to 
the  previous  surgery. 

Following  is  an  example  of  a hospital 
observation  service  on  the  same  day  as 
a procedure: 

• A patient  is  admitted  to  the  hospital 
observation  unit  for  observation  of  a head 
injury  by  a physician  who  repaired  a lac- 
eration of  the  scalp  in  the  emergency  de- 
partment. The  physician  would  bill  the 
observation  code  with  a CPT  modifier  25 
and  the  procedure  code. 


180 


Colorado  Medicine  for  May,  1993 


Cardiopulmonary  Resuscitation  (CPR)  Directives 


Colorado's  program  allowing 
patients  to  execute  Directives  for 
Cardiopulmonary  Resuscitation 
(CPR)  gets  under  way  this  month. 
Physician's  and  licensed  and  certi- 
fied health  care  facilities  statewide 
will  receive  informational  packets 
from  the  Colorado  Medical  Society 
regarding  the  implementation  of 
Colorado  Revised  Statute  15-18.6- 
101  which  provides  for  CPR  Direc- 
tives. 

By  initiating  a CPR  Directive, 
patients  can  document  their  wishes 
surrounding  CPR  and  can  be  sure 
that  emergency  medical  personnel 
and  first  respondents  abide  by  those 
wishes.  A CPR  Directive  form  has 
been  developed  and  approved  by  the 
Colorado  Board  of  Health.  This  form 
will  be  available  to  patients  only 
through  physicians'  offices  and 
licensed  health  care  facilities.  A CPR 
Directive  bracelet  and  necklace, 
with  a unique  logo,  are  available  for 
purchase  at  a cost  of  $26.00  by 
patients  who  execute  a CPR  Direc- 
tive form. 

This  is  important  for  physicians 
because  CPR  Directives  must  be 
signed  by  a physician.  They  are 
unlike  other  directives,  such  as  the 
Living  Will  or  the  Medical  Durable 
Power  of  Attorney  for  Health  Care 
Decisions,  since  those  forms  may  be 
completed  in  full  by  the  patient,  or 
an  attorney  may  assist  in  preparing. 
Colorado  law  recognizes  the  attend- 
ing physician's  role  in  the  process  of 
initiating  CPR  Directives  and  it 
ensures  this  role  in  two  ways:  1 ) by 
requiring  the  attending  physician's 
signature  on  all  CPR  Directives;  and 
2)  by  limiting  the  distribution  points 
of  the  Directive  form. 

Why  have  physicians  been  delegated 


this  responsibility ? Because  direc- 
tives involve  a medical  treatment 
decision  and  a CPR  Directive 
becomes  effective  immediately.  Its 
execution  is  made  in  the  context  of  a 
patient's  current  medical  status  and 
thus  requires  the  information  and 
support  of  a physician  who  under- 
stands that  status  and  can  discuss  it 
with  the  patient.  Other  directives  are 
executed  to  become  effective  at 
some  future  time  under  certain 
specified  circumstances.  Questions 
about  CPR  a patient  will  want 
answered  are: 

• What  is  the  medical  prognosis  of 
my  condition? 

• What  is  the  likelihood  that  I may 
need  CPR  in  the  course  of  my 
illness? 

• What  is  the  likelihood  of  pro- 
longed or  indefinite  dependence 
on  artificial  life  support  systems 
once  initiated? 

• What  is  the  outcome  of  withhold- 
ing or  withdrawing  CPR? 

• What  sorts  of  procedures  does  the 
term  "CPR"  include? 

Studies  indicate  that  patients  want  to 
discuss  directives  with  a physician 
and  they  want  the  physician  to  be 
the  initiator  of  the  discussion.  It  is 
appropriate,  therefore,  that  the 
Colorado  legislature  included 
physicians  in  the  implementation  of 
the  Act. 

Order  forms  for  CPR  Directive  forms 
are  provided  in  a packet 
being  mailed  in  May.  The  packet 
includes  information  about  the  Act 
(responsibilities  of  physicians, 
patients,  EMTs),  a sample  of  the  CPR 
Directive  Form,  and  instructions  on 
executing  the  CPR  Directive  form. 


Order  forms  for 
CPR  Directive  forms  are 
provided  in  a packet 
being  mailed  in  May, 
including: 

• information  about  the 
Act  (responsibilities  of 
physicians , patients , 
EMTs) 

• a sample  of  the  CPR 
Directive  form 

• instructions  on  execut- 
ing the  CPR  Directive 
form. 

Questions  regarding 
the  CPR  Directive  Pro- 
gram may  be  referred  to 
Diana  Wood , Colorado 
Medical  Society  779-5455 
or  800-654-5653. 


Colorado  Medicine  for  May,  1993 


181 


Doctors'  Day  1 993 

Photos  by  Gil  Maestas,  II 


H.R.  Safford,  III,  MD  chairs  the  Colorado  Medical  Political  Action  Committee 
when  he  is  not  busy  with  his  urology  practice,  but  he  is  also  an  avid  train 
collector.  He  put  part  of  his  large  collection  on  display,  and  explained  some  of 
the  fascinating  history  of  Lionel  trains. 


Vascular  surgery  is  a demanding 
profession,  but  Dr.  Charles  Brantigan 
(third  from  left  in  the  back,  with 
stethoscope)  unwinds  with  his  friends 
in  the  Denver  Brass.  Dr.  Brantigan  also 
pursues  photography  and  carving. 


Collecting  old  banjos  is  a 
passion  for  John  R.  Nye, 
MD.  Those  in  this  exhibit 
represented  Fairbanks 
(Boston)  from  1 900-  7 930. 
Dr.  Nye  is  an  Internist 
who  practices  at  Accord 
Medical  Center. 


A number  of  Colorado's  finest  medical  practitioners  demonstrated  that  their  interests  were 
not  limited  to  medicine  and  health,  in  an  exhibit  at  the  Denver  Medical  Library.  Physi- 
cians were  invited  to  display  their  hobbies  and  spare-time  interests.  As  you  can  see,  they 
have  an  amazing  variety.  Here  we  give  you  a representative  sample  of  the  excellence  of 
their  pursuits. 


Have  you  ever  considered  building  a 
boat  in  the  basement?  Dr.  Louis  Benton 
takes  his  hobby  a little  more  seriously, 
as  this  18  foot  Greenland  style  sea 
kayak  attests.  All  his  weekends  for  two 
months  were  spent  with  marine  grade 
plywood  and  epoxy  as  he  labored  on 
this  project.  In  his  spare  time,  Dr. 
Benton  is  a specialist  in  surgery  of  the 
upper  extremity. 


182 


Colorado  Medicine  for  May,  1993 


Physician  Hobby  Show 
March  30-April  16 


There  were  many  collections  in  the  exhibits  on  Doctors'  Day. 
One  concerned  ancient  medical  texts,  collected  by  Surgical 
Oncologist,  William  R.  Nelson,  MD.  Pictured  here  is  a medical 
text  written  by  the  first  full  time  professor  of  medicine  in  the 
western  hemisphere,  Dr.  Robley  Dunelison,  Thomas  Jefferson's 
personal  physician  and  the  founder  of  the  University  of  Virginia 
School  of  Medicine. 


A framed  letter  from 
Charles  Russel  and 
some  ancient  war 
clubs  highlight  the 
40-year  collection  of 
Dr.  Joe  Becky.  Dr. 
Becky  also  has 
antique  surgical 
field  Instruments 
and  mining  utensils 
which  remind  him 
of  his  boyhood 
home  in  Butte, 
Montana. 


The  talents  of  Richard  Planigan,  MD  are  legion,  as  proven  by 
his  impressive  collection  of  U.S,  International  and  world 
championship  rowing  medals.  Also  pictured  is  a representative 
of  his  painting  talent.  He  uses  watercolor,  oil  and  a variety  of 
media  to  express  himself. 


He  was  so  impressed 
during  his  visits  to 
Arches  National  Park 
in  Utah,  that  Dr. 
David  Claassen  ex- 
panded his  high 
school  hobby  into  a 
life-long  passion.  He 
lugged  a 50-year-old 
4X5  Linhof  view 
camera  up  and  down 
canyons  on  his  back, 
by  raft  through  the 
Grand  Canyon  and 
through  snow  on 
cross-country  skis. 
We  only  wish  we 
could  have  shown 
more  of  the  photos 
that  resulted. 


Dr.  Martin  P.  Dumler  spent  25  hours  carving  and 
another  25  hours  painting  this  wooden  Great  Horned 
Owl.  He  exibited  several  other  wood  carvings  as  well. 
Dr.  Dumler  is  a pathologist  in  Denver. 


Colorado  Medicine  for  May,  1993 


183 


A monthly  report  of 
current  and  on-going 
activities  of  the  Councils , 
Committees  and  Sections 
of  the  Colorado  Medical 
Society.  None  of  the 
information  herein  is 
meant  to  indicate  a policy 
or  position  statement  of 
the  Colorado  Medical 
Society.  This  report  is 
designed  only  to  inform 
CMS  members  of  their 
organization's  activities 
and  study  projects  at  the 
Council,  Committee  or 
Section  level. 


The  Colorado  Medical  Society 
(CMS)  Health  Care  Reform  Committee 
was  recently  created  to  assist  the 
Medical  Society  as  it  attempts  to 
decipher  the  array  of  health  care 
reform  initiatives  being  proposed. 

Committee  members  have 
invested  a good  deal  of  time  in 
defining  what  role  the  committee 
should  play.  They  concluded  that  the 
main  purpose  of  the  committee  is  to 
study  health  care  reform  initiatives 
on  a state  and  national  level  and  to 
function  as  a resource  to  the  CMS 
Board  of  Directors,  House  of  Del- 
egates and  general  membership, 
providing  them  with  accurate,  up  to 
date  information  on  these  initiatives. 
In  addition,  as  the  committee  studies 
health  care  reform  proposals  it  will 
compare  them  to  existing  CMS 
policy  on  health  care  reform  and 
make  recommendations  regarding 
refinements  to  that  policy. 

The  committee  has  decided  that 
in  order  to  operate  most  efficiently  it 
will  form  work  groups  that  will  work 
separately  and  then  report  back  to 
the  full  committee.  Three  work 
groups  have  been  formed  to  study 
the  following  topics:  Colorado 
health  care  reform  initiatives, 
national  health  care  reform  initia- 
tives, and  health  care  reform  initia- 
tives in  other  states. 

The  next  meeting  is  scheduled 
for  June  30.  Following  are  the  names 
of  committee  members: 

Robert  M.  Bogin,  M.D.,  Chair 

Thomas  J.  Allen,  M.D. 

Wm.  Carl  Bailey,  M.D. 

Richard  F.  Bakemeier,  M.D. 

Mary  J.  Berg,  M.D. 

Harrison  G.  Butler  III,  M.D. 


John  O.  Cletcher  Jr.,  M.D., 

Chair,  Colorado  Work  Group 

Jonathan  C.  Feeney,  M.D. 

L.  Barton  Goldman,  M.D. 

Mary  Jo  Jacobs,  M.D.,  Chair, 

National  Work  Group 

Mark  B.  Johnson,  M.D. 

Joel  M.  Karlin,  M.D. 

R.  Martin  Kiernan,  M.D. 

Muryl  L.  Laman,  M.D. 

Sherri  J.  Laubach,  M.D. 

Jeremy  A.  Lazarus,  M.D.,  Chair, 
Other  States  Work  Group 

Mark  Levine,  M.D. 

Bonnie  McCafferty,  M.D. 

Robert  D.  McCartney,  M.D. 

Louise  L.  McDonald,  M.D. 

M.  Ray  Painter,  M.D. 

Richert  E.  Quinn,  Jr.,  M.D. 

Alan  D.  Rapp,  M.D. 

James  R.  Regan,  M.D. 

Henry  J.  Roth,  M.D. 

James  M.  Satt,  M.D. 

John  A.  Sbarbaro,  M.D.,  MPH 

Theresa  A.  Scholz,  MSIII 

W.  George  Shanks,  M.D. 

Nick  Slenkovich,  MSI 

Terrance  J.  Sullivan,  M.D. 

Steven  j.  Thorson,  M.D. 

Leigh  Truitt,  M.D. 

Gary  VanderArk,  M.D. 

The  Physician/Patient  Advocacy 
Council  met  on  April  20  to  discuss 
managed  care  issues  with  representa- 
tives from  the  HMO  Association.  A 
report  of  these  proceedings  will  be 
included  in  a future  issue  of  Colo- 
rado Medicine. 

The  Workers'  Compensation 
Advisory  Committee  did  not  meet  in 
April  due  to  the  scheduling  of  the 
Interim  Meeting.  The  Chairman  and 
a number  of  members  of  the  WCAC 
participated  in  a panel  discussion 
and  workshop  held  at  the  Interim 


184 


Colorado  Medicine  for  May,  1993 


Meeting  in  Colorado  Springs.  The 
workshop  was  well  attended. 
WCAC's  next  meeting  is  scheduled 
for  May  1 2. 

The  Medicare  Advisory  Committee 

continues  to  address  Medicare 
problems  on  a monthly  basis  with 
Blue  Cross  and  Blue  Shield  of 
Colorado,  the  local  Medicare 
Carrier.  At  the  last  meeting  on  April 
12,  the  Carrier  clarified  appropriate 
use  of  observation  codes.  An  article 
explaining  the  use  of  observation 
codes  is  included  in  this  issue  of 
Colorado  Medicine.  The  next 
meeting  is  scheduled  for  May  10. 

Colorado's  air 
quality:  Physician 
input  needed 

The  CMS  Environment  Committee 

has  targeted  as  their  major  agenda 
item  for  1993  the  broad  topic  of 
health  effects  related  to  air  pollution. 
During  discussions  between  the 
Committee  and  representatives  of  the 
Air  Pollution  Control  Division  of  the 
Colorado  Department  of  Health  the 
Committee  learned  that  in  recent 
years,  Colorado's  medical  commu- 
nity has  had  little  input  into  regula- 
tory decisions  concerning  the  quality 
of  Colorado's  air.  The  regulators  with 
whom  the  Environment  Committee 
met  indicated  that  one  of  the  key 
roles  physicians  could  play  in 
helping  to  clean  up  Colorado's  air 
would  be  to  provide  to  the  Air 
Quality  Control  Commission, 
Colorado's  major  air  quality  board, 
data  from  studies  which  show 
evidence  of  links  between  health 
outcomes  and  specific  toxics, 


pollutants  or  combinations  of 
pollutants.  Currently  air  toxics  are 
not  regulated  in  Colorado. 

A second  way  that  physicians 
could  impact  air  quality  policy 
would  be  to  provide  testimony  to  the 
Air  Quality  Control  Commissioners 
at  their  monthly  meetings.  The  Air 
Quality  Control  Commission  meets 
on  the  third  Thursday  of  every  month 
at  9:00  a.m.  Meetings  last  from  half  a 
day  to  three  days  depending  on  the 
agenda.  Meetings  are  generally  held 
in  the  Sabin  Room  of  the  Colorado 
Department  of  Health,  4300  Cherry 
Creek  Drive  South,  Denver  (303) 
692-3180.  Testimony  is  taken  at  the 
beginning  of  each  meeting  on  issues 


not  on  the  agenda.  Testimony  on 
specific  agenda  items  is  heard  as 
they  come  up.  The  next  meeting  of 
the  Air  Quality  Control  Commission 
will  be  May  20,  1 993. 

Finally,  in  January  1 994  three  Air 
Quality  Commissioner  positions  will 
become  vacant.  Commissioners  are 
appointed  by  the  Governor  for  a 
three  year  term.  Applications  may  be 
obtained  from  Lynn  Livingston  at 
CMS  779-5455  or  1-800-654-5653. 


Donald  J.  Northey,  M.A. 

Clinical  Audiology 
Audiological  Consultants,  Inc. 

• General  Audiology 
• Hearing  aid  evaluations 
• Hearing  aid  dispensing,  service  and  aftercare 
• Amplified  stethoscopes 
• Noise,  swim  and  surgical  ear  plugs 
• Electronic  Shooters  Protection 
ENGLEWOOD  LAKEWOOD 

3575  S.  Sherman  St.,  Suite  #2  2020  Wadsworth,  #4 

761-7600  238-1366 

Providing  a rewarding  hearing  aid  experience  since  1970. 


Colorado  Medicine  for  May,  1993 


185 


Proceedings  of  the  House  of  Delegates 
Interim  Meeting,  1993 


The  Colorado  Medical 
Society  House  of 
Delegates  met  at  the 
Sheraton  Hotel , Colorado 
Springs > Colorado , on 
April  3-4 , 1 993  and  took 
the  following  actions: 


REFERENCE  COMMITTEE  ON  BOARD  OF  DIRECTORS/CONSTITUTION  & 
BYLAWS 

Adopted  a Resolution  which  allows  AMA  Delegates  and  Alternates  to 
concurrently  hold  any  elected  office. 

Adopted  a Resolution  which  increases  the  honorarium  for  President  and 
President-Elect  to  $50,000  and  $25,000  respectively. 

Adopted  a Resolution  which  states  that  the  Colorado  Medical  Society  and  its 
physicians  shall  not  discriminate  on  the  basis  of  sexual  orientation,  age, 
gender,  religion,  national  origin,  skin  color  or  disability. 

Adopted  a Resolution  which  states  that  the  Colorado  Medical  Society  shall 
endeavor  to  increase  the  number  of  primary  care  physicians  in  Colorado  with 
emphasis  on  the  rural  areas. 

Adopted  a Resolution  to  continue  the  Women  in  Medicine  Section,  Young 
Physicians  Section  and  the  Resident  Physician  Section  and  to  temporarily 
suspend  the  Hospital  Medical  Staff  Section. 

Adopted  a Resolution  to  make  certain  housekeeping  revisions  to  the  CMS 
Continuing  Medical  Education  (CME)  mission  statement. 

Adopted  a Resolution  which  gave  voting  rights  to  the  Board  of  Directors 
representative  from  the  Medical  Student  Component. 

Adopted  a Resolution  which  instructs  the  Council  on  Ethical  and  Judicial 
Affairs  to  continue  to  study  and  revise  as  needed  the  policy  on  self-referrals. 
Adopted  a Resolution  which  increased  the  Graduate  Dues  from  $10  to  $30. 
Adopted  a Resolution  which  sunsetted  the  current  CMS  Strategic  Plan  in 
anticipation  of  developing  a new  one  during  the  President's  Planning  Confer- 
ence in  July,  1 993. 

Adopted  a Resolution  which  will  allow  direct  membership  in  CMS  for  any 
physician  in  a formal  internship,  residency  or  fellowship  training  program. 
Accepted  for  filing: 

Progress  Report  - AMA  Delegation 

Progress  Report  - Board  of  Directors 

Progress  Report  - Council  on  Ethical  & Judicial  Affairs 

Progress  Report  - Council  on  Legislation 

Progress  Report  - Council  on  Legislation  - COMPAC 

Progress  Report  - Executive  Director 

Progress  Report  - CMS  Education  & Research  Foundation 

Progress  Report  - Grievance  Review  Committee 

Progress  Report  - Organizational  Study  Committee 

Progress  Report  - Council  on  Professional  Education 

Progress  Report  - Physician  Health  Issues  Committee 

Progress  Report  - Women  in  Medicine  Section 


REFERENCE  COMMITTEE  ON  COMMUNITY  HEALTH  ISSUES/MEDICAL 
SERVICE 

Adopted  a Resolution  to  seek  legislation  that  will  protect  patients  from  laser 
surgery  performed  by  persons  not  licensed  to  practice  medicine  in  Colorado. 


186 


Colorado  Medicine  for  May,  1993 


Proceedings  of  the  House  of  Delegates  (Continued) 

Adopted  a Resolution  which  established  protocols  for  office  based  physicians  on  recognizing,  reporting,  treating  and 
referring  domestic  violence  victims. 

Adopted  a Resolution  to  develop  legislation  which  would  enhance  and  expedite  the  procurement  of  transplantable 
organs. 

Accepted  for  filing: 

Progress  Report  - Council  on  Community  Health  Issues 
Progress  Report  - Hospital  Medical  Staff  Section 
Progress  Report  - Council  on  Medical  Service 

REFERENCE  COMMITTEE  ON  PHYSICIAN/PATIENT  ADVOCACY 

Adopted  a Resolution  which  further  refined  the  Colorado  Medical  Society's  policy  on  managed  care. 

Adopted  a Resolution  which  states  that  the  Colorado  Medical  Society  supports  the  physician's  right  to  determine 
who  shall  be  present  during  an  independent  medical  examination. 

Adopted  a Resolution  which  states  that  the  Colorado  Medical  Society  will  be  opposed  to  any  form  of  global  budget- 
ing or  expenditure  caps. 

Adopted  a Resolution  that  the  Colorado  Medical  Society  through  the  AMA,  urge  the  Health  and  Human  Services  to 
initiate  an  entirely  new  and  current  study  of  malpractice  costs  and  that  the  AMA  seek  modification  to  the  Geographic 
Practice  Cost  Indices  to  incorporate  the  new  findings. 

Adopted  a Resolution  that  the  Colorado  Medical  Society  reaffirm  its  existing  policy  on  managed  care  and  strongly 
lobby  to  have  this  policy  included  in  any  health  care  legislation  which  might  affect  the  provision  of  health  care  to  the 
citizens  of  Colorado. 

Accepted  for  filing: 

Progress  Report  - Council  on  Physician/Patient  Advocacy  (PPAC) 


Highlights  of  Board  of  Director's  Meeting 

April  2,  1993 

CMSA: 

Mrs.  Pam  Laman,  President,  reported  that  officers  for  the  upcoming  year  had 
been  elected.  Mrs.  Laman  will  serve  a second  term  as  President. 

AMA  Delegation: 

Ms.  Maloney  reported  there  will  be  a conference  call  on  April  1 5th  to  solicit 
and  prepare  resolutions  to  be  sent  to  the  AMA  Annual  meeting  in  June. 

Medical  Student  Component: 

Ms.  Maura  Lofaro  reported  that  the  Component  is  looking  for  additional 
funding  in  order  to  send  more  Delegates  to  the  AMA  Annual  Meeting  in  June. 
Ms.  Lofaro  also  stated  that  a mentor  program  is  being  developed. 

Board  of  Directors: 

The  Board  approved  the  recommendation  from  the  Organizational  Study 
Committee  to  temporarily  suspend  the  Hospital  Medical  Staff  Section. 

The  Board  approved  a motion  to  form  a sub-committee  to  research  and  gain 
an  understanding  of  the  income  and  outgo  of  funds  from  CMS/ERF  and  AMA/ 
ERF. 

The  Board  approved  a request  from  the  HIV  Committee  to  expand  their 
charge  to  include  TB  and  other  emerging  infectious  diseases.  The  name  will 
be  changed  to  The  Infectious  Disease  Committee. 

The  Board  approved  the  use  of  the  Department  of  Health  ruling  regarding  the 
fees  to  charge  for  copying  medical  records,  i.e.,  $10  for  the  first  ten  pages  and 
25  cents  for  each  page  thereafter. 

Colorado  Medicine  for  May,  1993 


187 


Delegate  Attendance  — 1993  Interim  Meeting 


These  are  the  people  who 
represented  you  in  making 
the  decisions  on  the 
preceding  pages.  Please 
thank  them  for  their 
participation. 


Arapahoe 

Bartee,  Roy  M II,  MD 
Bartlett,  Max  D,  MD 
Burks,  Jack  S,  MD 
Jolly,  Susan  L,  MD 
Kruse,  Robert  L,  MD 
Stecher,  Karl  Jr,  MD 
Steffen,  Grant  E,  MD 
Thulin,  Barbara  W,  MD 
Aurora-Adams  County 
Buckley,  Jerome  M,  MD 
Clark,  Sal  I ie  B,  MD 
Gottula,  Roderic  D,  MD 
Heaton,  Angeline  D,  MD 
Heaton,  Carl  E,  MD 
Manguso,  Robert  L,  MD 
Rich,  John  D,  MD 
Sundland,  Barry  R,  MD 
Visconti,  Paul  B,  MD 
Vitanza,  Joanne  M,  MD 
Boulder  County 
Berg,  Kevin  R,  MD 
Kelley,  Severance  B,  MD 
Mooney,  Herbert  S Jr,  MD 
Rubright,  Mark  W,  MD 
Steinbaugh,  John  R,  MD 
Wherry,  Harry  L,  MD 
Clear  Creek  Valley 

Brundige,  Richard  L,  MD 
Campbell,  Bernard  E,  MD 
Doig,  William  L,  MD 
Dorr,  Lugene  A,  MD 
Eaton,  Wyley  E,  MD 
Golbert,  Thomas  M,  MD 
Laubach,  Sherri  J,  MD 
Mains,  Charles  W,  MD 
Mann,  James  G,  MD 
Netz,  Howard  E,  MD 
Oppenheim,  Walter  H,  MD 
Sadler,  Dean  L,  MD 
Santoro,  John  A Jr,  MD 
Tarkanian,  Malcolm  A,  MD 
Tegtmeier,  Ronald  E,  MD 
Ting,  | Karyl,  MD 
Weston,  Eugene  L,  MD 


Colorado  Chapter,  American  College 
of  Emergency  Physicians 
Dillon,  Jack  T,  MD 
Colorado  Society  of  Clinical 
Pathologists 

Stienmier,  Richard  H,  MD 

Colorado  Society  of  Internal 
Medicine 

Claassen,  David  W,  MD 

Colorado  Allergy  Society 
Baswell,  Bonnie  J,  MD 
Colorado  Gyn/OB  Society 
Rapaport,  Alan  M,  MD 
Colorado  Ophthalmological  Society 
Welch,  John  R,  MD 

CURECANTI 

Hopple,  Lynwood  M,  MD 
Denver 

Anneberg,  A Lee,  MD 
Bakemeier,  Richard  F,  MD 
Ballinger,  Carter  M,  MD 
Bogin,  Robert  M,  MD 
Bumgarner,  Frank  E Jr,  MD 
Butterfield,  D G,  MD 
Cochrane,  David  R,  MD 
Cook,  William  R,  MD 
Evans,  Richard  P,  MD 
Fink,  Donald  W,  MD 
Foust,  Glenn  T III,  MD 
Hawkins,  Joy  L,  MD 
Jacobs,  Mary  Jo,  MD 
Jacobson,  Eugene  D,  MD 
Kail,  Thomas  J,  MD 
Kandel,  George  E,  MD 
McCartney,  Robert  D,  MD 
Nelson,  Nancy  E,  MD 
Owens,  J Cuthbert,  MD 
Regan,  James  R,  MD 
Rhodes,  Edward  A,  MD 
Sbarbaro,  John  A,  MD 
Schemmel,  Janet  E,  MD 
Schramm,  Victor  L Jr,  MD 
Stigler,  Del,  MD 

Walker,  Louise  D Converse,  MD 
Wilson,  William  B Jr,  MD 
Woodard,  W Donald,  MD 


Colorado  Medicine  for  May,  1993 


Delegate  Attendance 


1993  Interim  Meeting 


El  Paso  County 

Barry,  Francis  J,  MD 
Brusenhan,  J Richard,  MD 
Crawford,  Lewis  A,  MD 
Emeis,  William  E,  MD 
Feinsod,  Fred  M,  MD 
Gieringer,  Gary  V,  MD 
Gifford,  Marilyn  j,  MD 
Hanson,  J R,  MD 
LaVoo,  John  W,  MD 
Lloyd,  William  E,  MD 
Muth,  John  B,  MD 
Nielsen,  Peter  G,  MD 
Pollard,  Joseph  S Jr,  MD 
Rapp,  Alan  D,  MD 
Rubinow,  Sidney  D,  DO 
Schwartz,  David  J,  MD 
Sherman,  John  L,  MD 
Simerville,  James  J,  MD 
Spaulding,  Duane  R,  MD 
Struck,  Teresa  H,  MD 
Telatnik,  Stephen  C,  MD 
Fremont  County 
Gamache,  Peter  J,  MD 
Larimer  County 
Chase,  Jerry  A,  MD 
Ezell,  William  W,  MD 
Giansiracusa,  Richard  F,  MD 
Hailey,  Mark  A,  MD 
Hammond,  Richard  O,  MD 
Honea,  Bertrand  N III,  MD 
Stephens,  Floyd  V Jr,  MD 
Tagge,  Gordon  K,  MD 
Las  Animas  County 
McFarland,  Douglas  M,  MD 
Medical  Student  Component 
Johnson,  Brian  L 
Slenkovich,  Nick 
Wepman,  Carolyn  J 
Mesa  County 
Jones,  Paul  B,  MD 
Klein,  M G,  MD 
Linnemeyer,  Robert  F,  MD 
Magraw,  Bronwen  J,  MD 
Sadler,  Theodore  R Jr,  MD 


Morgan  County 
Thompson,  Patrick  L,  MD 
Mt.  Sopris  County 
Painter,  M Ray  Jr,  MD 
Otero  County 
Morse,  Jeffrey  M,  MD 
Satt,  James  M,  MD 
Pueblo  County 
Bennett,  Dana  R,  MD 
Drake,  Robert  L,  MD 
Gaide,  Thomas  K,  MD 
Meeuwsen,  James  W,  MD 
Morgan,  Alethia  E,  MD 
Parks,  Gary,  MD 
Puls,  Theodore  J,  MD 
Ryals,  Jarvis  D,  MD 
Snyder,  Charles  E,  MD 
San  Luis  Valley 
Brownrigg,  Richard  L,  MD 
Culp,  Raymond  M,  MD 
Weld  County 
Cornell,  F Michael,  MD 
Kemme,  Richard  J,  MD 
Quinn,  Richert  E Jr,  MD 
Tyburczy,  Joseph  A Jr,  MD 
Women  in  Medicine 
Justin,  Ingrid  M,  MD 


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Colorado  Medicine  for  May,  1993 


189 


cience  Fair  Winners 


moved  on  this  year  to  teach  his  Macintosh  computer  to  diagnose  cancer.  It's 
still  a little  primitive,  but  it  looks  like  he's  on  to  something  here.  Diann 
Miyake  expanded  her  project  from  last  year  to  study  how  far  contagion  can 
spread  when  blood  products  are  spilled  in  offices,  labs  or  operating  rooms. 
She  discovered  that  it's  much  farther  than  many  physicians  believe. 

As  good  as  these  were,  and  they  were  both  excellent,  there  was  one 
better.  Colleen  Morgan,  a senior  at  Cherry  Creek  High  School,  used  the 
Polymerase  Chain  Reaction  to  identify  estrogen  receptor  MRNA  in 
Gliobastoma  cell  lines.  Though  this  procedure  is  fairly  common  in  forming 
a prognosis  in  breast  cancer  cases,  this  project  breaks  some  new  ground  in 
applying  it  to  brain  tumors.  Be  sure  to  stop  by  Colleen's  exhibit  at  the  Annual 
Meeting  for  an  intellectually  challenging  discussion  of  these  issues. 


The  Thirty-Eighth  Annual  Colorado  State  Science  Fair 
was  held  in  April  at  Colorado  State  University  in  Fort 
Collins.  Students  from  all  over  the  state  competed  in 
botany,  earth  and  environmental  sciences,  engineer- 
ing, health  and  behavioral  sciences,  mathematics  and 
computer  science,  physical  science  and  zoology. 

The  Colorado  Medical  Society  has  long  been  a 
supporter  of  the  Science  Fair  and  this  year  is  no 
exception.  Two  students  were  selected  to  receive  a 
$100  Savings  Bond  and  the  chance  to  show  their 
exhibits  at  the  Annual  Meeting  in  September.  The 
CMS  encourages  science  education  in  a variety  of 
contexts  as  part  of  our  advocacy  of  excellence  in 
medicine  and  promoting  the  public  health. 

In  the  Junior  Division  Medical  category,  the  win- 
ner was  Ashley  Kircher  of  Colorado  Springs.  Her 
project,  Blood  on  the  Counter,  examined  the  risk  of 
acquiring  infection  after  a spill  of  blood  in  a medical 
office  or  laboratory.  She  tested  how  long  a sample 
would  remain  infectious  after  a spill.  Fook  for  her  at 


KLMI 


the  Annual  Meeting,  the  results  may  surprise  you. 

In  the  Senior  Division,  the  decision  was  much  more  difficult. 
Fastyear,  there  were  twowinners  i n this  division  and  both  ofthem 
had  improved  their  projects  significantly  this  year. 
Warren  Gasper,  who  last  year  studied  the  effects  of 
electromagnetic  radiation  from  computer  screens, 


190 


Colorado  Medicine  for  May,  1993 


OFFICIAL  CALL  FOR  NOMINATIONS 

The  Colorado  Medical  Society  Nominating  Committee  is  seeking  nominations  for  the  following  elected  positions  for 
the  1 993-94  term  of  office. 

PRESIDENT-ELECT  (from  out-state) 

SPEAKER  OF  THE  HOUSE 
VICE  SPEAKER  OF  THE  HOUSE 
AMA  DELEGATE  (two) 

AMA  ALTERNATE  DELGATE  (two) 

Please  contact  Dr.  Ronald  E.  Tegtmeier,  Chair,  at  (303)  278-2600  or  Mary  Lee  Johnston,  CMS  staff,  1 -800-654-5653 
or  (303)  779-5455  with  names  of  interested  persons.  The  Nominating  Committee  will  be  meeting  during  the 
President's  Planning  Conference  in  Fort  Collins,  Colorado,  July  1 6-1  7,  1 993,  to  interview  prospective  candidates. 
If  necessary,  interviews  can  be  scheduled  for  another  time. 


"That's  all  there  is  left  of  it." 

That's  a statement  made  about  a lot  of  things  in  life.  It  was  a 
stepping  stone,  a way  stop,  an  historic  marker,  and  in  this  case  this 
is  all  there  is  left  of  the  former  CMS  Building  at  1 809  Williams, 
referred  to  most  frequently  as  "the  Williams  Street  Building".  CMS 
sold  it  in  1972,  then  in  1973  headed  for  tenancy  in  the  Denver 
Medical  Library  Foundation  building  at  1 9th  and  Gilpin  where  the 
offices  remained  until  April,  1982.  CMS  then  moved  to  6825  East 
Tennessee. 

From  there,  our  next  move  was  to  6061  So.  Willow  Drive  in 
the  Tech  Center,  then  to  5575  DTC  Parkway.  Finally  (or  at  least, 
most  recently)  it  was  to  7800  E.  Dorado  Place  in  the  Copic 
insurance  Building,  which  seems  a fair  bet  to  be  as  permanent  as 
homes  get. 

Many  won't  remember  or  even  know  about  the  Williams 
Street  Building  as  part  of  the  Society's  history.  In  fact,  some  of  us 
have  a hard  time  remembering  where  CMS  was  before  its  current 
location. 

Williams  Street  was  the  Society's  first  move  of  permanency 
when  it  purchased  the  property  in  1951  and  left  its  long-time 
headquarters  on  the  8th  floor  of  The  Republic  Building  at  1 608 
Tremont.  CMS  had  been  in  the  building  since  1932.  Previously, 
CMS  had  three  different  locations  in  the  Metropolitan  Building  on 
the  other  side  of  the  block. 


All  that  remains  of  former  CMS  Building  at  18th  & 
Williams  in  Denver.  The  building  was  demolished 
for  other  development  on  the  block. 


Colorado  Medicine  for  May,  1993 


191 


EPARTMENT  OF 


Health 


Public  Education 

Colorado  Women  S Seven  areas  have  been  selected  as 

Cancer  Control  Initiative  "Pilot"  communities  to  test  specific 

educational  interventions,  tailored  to 
the  cultural  and  socio-economic 
Continued  from  April  characteristics  of  the  women.  In 

these  areas,  special  outreach  projects 
to  older  women,  Blacks  and  Hispan- 
ics  are  being  developed.  The  pilot 
sites  are:  Metro  Denver  (with  specific 
emphases  on  northwest  Denver, 
northeast  Denver  and  selected  areas 
in  Adams  and  Arapahoe  counties); 
the  Western  Slope  (Mesa,  Delta, 
Garfield  counties);  Northeast  Colo- 
rado (Logan,  Morgan,  Phillips, 
Sedgwick,  Washington,  Yuma 
counties);  North  Central  Colorado 
(Larimer,  Weld  counties);  Southeast 
Colorado  (Otero,  Bent,  Prowers 
counties);  and  the  Arkansas  valley. 

In  these  areas,  staff  from  the 
health  department  have  teamed  up 
with  residents  to  create  community 
coalitions  whose  purpose  is  to 
educate  and  motivate  women  to  take 
responsibility  for  their  health. 
Information  about  breast  and  cervi- 
cal cancer  is  shared  through  speakers 
bureaus  that  work  with  small  groups 
in  intimate  setting  where  women  can 
ask  questions  they  might  not  feel 
comfortable  asking  in  a doctor's 
office  or  in  a large  meeting. 

Women  participating  in  the  local 
coalitions  are  receiving  training 
about  community  organizing  and 
building  relationships  with  the 
media.  Many  are  also  featured  in  a 
calendar  created  by  participants 
which  provides  messages  and  in- 
depth  information  about  women's 
health.  The  calendars  are  presented 
to  women  who  attend  the  speakers 
bureau  presentations. 


Professional 

Education 

The  goal  of  this  activity  is  to  inform 
and  motivate  health  care  profession- 
als to  perform  regular  breast  and 
cervical  cancer  screening  and  to  be 
sensitive  to  the  informational  needs 
and  fears  of  their  clients.  Aimed  at 
nurses  and  physicians,  training  is 
provided  to  improve  clinical  skills  in 
breast  and  cervical  exams.  A free 
resource  manual  for  providers  will 
be  available  this  August.  It  will 
contain  pertinent  information  about 
breast  and  cervical  cancer  and 
include  ideas  for  promoting  adher- 
ence to  screening  guidelines. 

Quality 
Assurance — 
Mammography 

Program  staff  surveyed  all  mammog- 
raphy centers  (144)  in  the  state  to 
determine  the  scope  of  their  quality 
assurance  procedures.  From  the  100 
centers  who  responded,  staff  mem- 
bers are  working  with  the  advisory 
committee  to  compile  information 
about  training  needs  and  to  get  a 
picture  of  the  quality  of  service 
delivery  in  Colorado. 

The  program  has  conducted  on- 
site inspections  of  some  65  centers 
who  are  participating  providers  in 
the  Colorado  Mammography  Advo- 
cacy Project  (CMAP),  a tracking, 
screening  and  surveillance  project 
also  sponsored  by  the  Cancer 
Control  Program. 

The  quality  assurance  advisory 
group  has  been  drawn  into  the  state 
legislative  arena  as  well.  As  of  this 


192 


Colorado  Medicine  for  May,  1993 


March,  HB  93-1  1 85  (Concerning  the 
Assurance  of  Quality  of  Mammogra- 
phy Exams)  by  Rep.  Shirleen  Tucker 
and  Sen.  Dave  Wattenberg,  is 
wending  its  way  through  the  legisla- 
tive process.  The  bill  would  require 
that  radiological  technicians  in 
Colorado  meet  a basic  level  of 
education  and  training  or  proof  of 
experience  to  perform  mammogra- 
phy. Further,  the  bill  designates  this 
committee  as  an  advisory  body  to 
the  Colorado  Board  of  Health  as  it 
issues  mammography  regulations 
and  begins  to  implement  the  federal 
"Mammography  Quality  Standards 
Act  of  1992." 

Quality 
Assurance — 
Cervical  Cytology 

There  are  41  laboratories  throughout 
the  state  who  process  cervical  tests. 
Project  staff  have  surveyed  the 
laboratories  to  determine  their 
current  quality  assurance  practices 
and  assess  future  training  needs. 

They  have  sponsored  three  training 
sessions  for  technicians  and  manag- 
ers and  will  be  overseeing  on-site 
inspections  once  CUA  rules  of  1992 
are  finalized. 

Service  Delivery 

The  staff  is  responsible  for  contrac- 
tual arrangements  and  service 
provision  for  eligible  women  who 
meet  age  and  income  requirements 
and  lack  health  insurance  coverage. 
The  services  provided  include:  pap 
smears,  pelvic  exams,  clinical  breast 
exams,  mammograms,  and  limited 
diagnostic  procedures  including 
colposcopies,  repeat  pap  smears, 


Department  of 


repeat  breast  exams.  By  August, 

1993,  surgical  consults  and  fine- 
needle  aspirations  will  be  added 
services. 

Services  are  delivered  through  a 
statewide  network  of  local  health 
departments,  community  nurses, 
family  planning  clinics,  Planned 
Parenthood,  Family  Medicine 
residents,  hospitals,  laboratories  and 
mammography  centers.  The  program 
has  annual  budgets  of  $3.5  million, 
60%  of  which  is  used  to  subsidize 
these  services.  In  1992,  1,781 
mammographies  were  provided  and 
2,  981  pap  tests  and  1 093  col- 
poscopies performed. 

Tracking  and 
Follow-up 

Working  through  the  Colorado 
Mammography  Advocacy  Project 
(CMAP),  information  about  each 
woman  is  collected  from  the  32 
participating  mammography  centers. 
It  includes  breast  cancer  risk  factors, 
screening  history,  screening  results, 
diagnostic  procedures  and  outcomes. 
CMAP  also  sends  out  reminders  to 
women  and  their  physicians  about 
re-screening  dates  and  diagnostic 
follow-up  procedures,  as  needed. 
CMAP's  data  base  already  has  over 
80,000  records,  including  3,800 
which  are  from  women  participating 
in  the  subsidized  program.  This 
tracking  project  benefits  individual 
women  and  their  physicians  by 
calling  attention  to  necessary  follow- 
up procedures.  It  will  benefit  all 
women  throughout  the  state  by 
helping  the  medical  community 
design  future  approaches  to  the 
growing  threat  of  breast  cancer.  A 
modified  version  of  CMAP  is  also 


tracking  data  on  cervical  screening 
and  results. 

Surveillance  and 
Evaluation 

Project  results  are  shared  with 
Colorado's  medical  community,  the 
National  Cancer  Institute  and  the 
National  Centers  for  Disease  Preven- 
tion and  Control.  Evaluations  will 
answer  such  questions  as  whether 
the  public  and  professional  educa- 
tion efforts  increase  the  number  of 
women  who  are  regularly  screened, 
and  whether  there  is  an  improve- 
ment in  the  morbidity  and  mortality 
rates  associated  with  breast  and 
cervical  cancer. 

Conclusion 

The  totality  and  impact  of  this 
project  is  definitely  larger  than  all  of 
its  parts.  The  project  is  saving  the 
lives  of  Colorado  women  through 
earlier  detection  of  cancer.  It  is 
creating  new  relationships  among 
women  in  the  participating  commu- 
nities, women  whose  age,  ethnic 
origins  and  socio-economic  status 
may  have  kept  them  apart.  It  is 
bringing  public  and  private  health 
care  professionals  together  to  design 
and  evaluate  interventions,  with  the 
goal  of  saving  many  lives.  It  is 
linking  participating  states  together 
and  it  is  hoped  to  produce  results 
which  can  be  put  to  work  throughout 
the  nation  in  the  ongoing  battle 
against  breast  and  cervical  cancer. 

If  you  are  interested  in  learning 
more  about  this  project  and/or 
joining  a committee,  your  participa- 
tion is  welcome.  Please  call  the 
Cancer  Control  Program  at  (303) 
692-2520  for  further  information. 


Colorado  Medicine  for  May,  1993 


193 


L 


ETTERS 


Please  send  your  letters  to 
Editor ; Colorado 
Medicine,  PO  Box  17550 , 
Denver, , CO  80217-0550 


Ms.  Kathy  Walsh 
KCNC  TV  Channel  4 
1 044  Lincoln 
Denver,  CO  80203 
Dear  Ms.  Walsh; 

I hope  that  you  are  aware  of  the 
tremendous  disservice  that  you  have 
done  to  certain  members  of  the 
medical  profession  and  to  the 
patients  for  whom  they  care  by  virtue 
of  your  story  on  physicians  and  the 
BME.  I happen  to  use  the  services  of 
one  of  the  physicians  in  your  story, 
Cynthia  Owens-Dunlop,  for  a couple 
of  days  each  month  in  one  of  our 
clinics.  I am  aware  of  the  difficulties 
encountered  by  Dr.  Owens-Dunlop, 
and  can  tell  you  that  they  pertain  to 
personal  medical  problems  and 
treatment  for  the  same  by  fellow 
professionals  in  what  some  would 
regard  as  an  incompetent  manner. 
This  situation  has  in  no  way  im- 
paired her  medical  abilities,  and  I 
can  verify  that  she  is  one  of  the  most 
complete  and  thorough  physicians 
who  provide  services  in  our  clinics.  I 
was  aware  of  the  situation  which  led 
to  a stipulation  on  her  license,  and 
even  though  it  is  a matter  of  public 
record,  I think  it  is  a gross  invasion  of 
Dr.  Owens-Dunlop's  privacy  to 
make  it  a matter  of  widespread 
public  dissemination. 

I hope  that  you  are  aware  or  can 
become  aware  of  the  somewhat 
subtle  way  in  which  the  Colorado 
Board  of  Medical  Examiners  must  do 
its  job.  Many  of  the  complaints 
received  by  the  Board  are  the  result 
of  poor  understanding  on  the  part  of 
patients  concerning  their  medical 
treatments,  and  have  no  significance 
whatsoever.  Other  complaints  lead 
to  the  uncovering  of  inadequacies  or 
problems  on  the  parts  of  certain 
physicians  involving  their  personal 
lives,  overuse  of  alcohol,  medica- 


tions, or  similar  situations.  In  many 
of  these  cases  the  involved  physician 
will  agree  to  a stipulation  on  the 
license  as  part  of  a rehabilitation 
plan.  In  many  other  cases,  especially 
in  those  involving  ongoing  profes- 
sional incompetence,  the  involved 
physicians  will  obtain  legal  counsel 
and  fight  quite  successfully  to  avoid 
any  stipulation  being  placed  upon 
their  licenses.  Such  physicians  take 
the  adversarial  rather  than  the 
cooperative  role  in  dealing  with  the 
Board,  and  it  often  takes  many  years 
for  some  action  to  be  completed  to 
limit  their  licenses.  These  latter 
physicians  are  the  ones  who  present 
the  most  danger  to  the  public,  and 
yet  the  board  often  has  inadequate 
power  to  deal  with  their  problems.  I 
believe  that  you  may  have  singled 
out  those  particular  physicians  for 
public  identification  who  are  actu- 
ally cooperating  with  the  board  in  a 
sincere  rehabilitation  effort,  and  who 
pose  no  particular  threat  to  the 
public.  In  addition,  it  is  likely  that 
your  actions  will  have  the  effect  of 
reducing  the  willingness  of  any 
impaired  physician  to  cooperate  with 
the  board,  since  doing  so  may  result 
in  public  identification  on  Channel  4 
News.  This  will  lead  to  an  increas- 
ingly adversarial  situation  with  fewer 
constructive  outcomes. 

In  summary,  I feel  that  you  have 
done  a disservice  to  those  particular 
physicians  identified  in  your  story 
whose  names  were  presented  to  the 
public  without  comment.  You  may 
well  have  chosen  to  tell  the  truth, 
and  perhaps  nothing  but  the  truth, 
but  you  have  not  told  the  whole 
truth.  Therein  lies  the  problem.  If  you 
have  any  questions,  please  do  not 
hesitate  to  contact  me. 

Cordially, 

Thomas  J.  Allen , M.D. 


194 


Colorado  Medicine  for  May,  1993 


Regulatory  Changes 

At  their  March  1 6,  1 993  meet- 
ing, the  Board  of  Health  made  the 
following  amendments  to  the  Code 
of  Colorado  Regulations: 

HIV  Reporting:  Positive  latex 
agglutination  tests  for  HIV  and  CD4 
counts  <500  mm3 or  CD4%  <29% 
regardless  of  HIV  test  results,  were 
added  to  the  list  of  what  laboratories 
shall  report  to  the  Colorado  Depart- 
ment of  Health. 

When  associated  with  other 
clinical  or  laboratory  evidence  of 
HIV  infection,  the  Board  of  Health 
defines  a CD4  test  result  in  the  range 
listed  above  as  the  primary  immuno- 
logic measure  indicating  severe  HIV 
infection  and  when  less  than  200 
mm3,  as  defining  AIDS.  The  Health 
Department  will  destroy  personal 
identifying  information  on  all 
persons  with  CD4  results  in  the 
reportable  range  if  investigation 
subsequent  to  the  report  finds  no 
evidence  of  infection. 

Infant  Immunization:  The  fee 
that  private  practitioners  may  charge 
the  Medicaid  program  for  adminis- 
tering, reporting,  and  tracking  an 
immunization  required  by  rule  VI  to 
a Medicaid-enrolled  infant  shall  be  a 
maximum  of  six  dollars  and  fifty 
cents  per  vaccine.  A vaccine  recipi- 
ent may  not  be  denied  vaccine 
provided  by  the  Centers  for  Disease 
Control  and  Prevention  federal  grant 
because  of  the  inability  to  pay  the 
administrative  fee. 

Prescription 
medicines  for  the 
medically  indigent 

The  Pharmaceutical  Manufacturers 
Association  has  published  a directory 


Medical 


News 


to  assist  physicians  in  obtaining 
prescription  medicines  for  their 
patients  who  are  unable  to  afford 
them. 

This  directory  lists  59  prescrip- 
tion drug  indigent  programs  that  are 
provided  by  their  member  compa- 
nies. Under  each  program  is  infor- 
mation about  how  to  make  a request 
for  assistance,  what  prescription 
medicines  are  covered  and  some 
basic  eligibility  criteria. 

This  directory  may  be  ordered  by 
writing  the  Pharmaceutical  Manufac- 
turers Association,  1 1 00  1 5th  St  NW, 
Washington  DC  20005.  There  is  no 
charge. 

Physicians  may  also  obtain 
information  by  calling  1-800-PMA- 
INFO.  When  provided  with  the 
prescription  medicine  required,  the 
operator  will  refer  the  physician  to 
the  appropriate  company  programs. 

Practice  Guideline 

The  US  Department  of  Health  and 
Human  Services  has  developed 
clinical  practice  guidelines  for 
urinary  incontinence  in  adults.  A 
copy  may  be  obtained  by  calling 
CMS,  Marilyn  Barton  or  Lynn 
Livingston.  This  guideline  is  not 
endorsed  by  CMS. 

Child  Fatality 
Review 

The  Colorado  Child  Fatality  Review 
Committee  (CFR)  recently  released 
new  data  concerning  childhood 
deaths  in  Colorado.  This  report 
includes  data  on  all  childhood 
deaths  from  birth  through  age  16  for 
1989-1990.  Data  for  1991  has  been 
collected  and  will  be  published  this 
year. 

The  Colorado  Medical  Society  is 


represented  on  this  committee  by  a 
number  of  physicians  and  staff. 

Summary  of  Findings: 

• There  were  1,847  child  deaths  in 
Colorado  during  1 989-1  990 

• Children  who  died  were  more 
likely  to  be  under  1 year  of  age 
(68%),  male  (60%),  and  white 
(68%). 

• More  deaths  were  to  Black  and 
Hispanic  children  (29%)  than 
would  be  expected  based  on  the 
proportion  of  these  children  in  the 
Colorado  population  (22%). 

• Mothers  of  infants  who  died  were 
more  likely  to  be  young,  unmar- 
ried, and  have  less  education  than 
mothers  of  all  babies  born  in  1 990 
in  Colorado. 

• The  manner  of  death  for  most 
children  was  natural  (79%) 
followed  by  accidental  (15%).  As 
the  age  of  the  child  increased, 
fewer  deaths  were  due  to  natural 
causes  and  more  to  accident, 
suicide,  and  homicide. 

• The  four  leading  underlying  causes 
of  death  were  perinatal  conditions 
(27%),  injury  (20%),  congenital 
anomalies  (18%),  and  SIDS  (14%). 

• The  four  leading  underlying  causes 
of  traumatic  death  were  motor 
vehicle  traffic  (36%),  suicide  ( 

1 2%),  homicide  (1 1%),  and 
drowning  (9%). 

For  further  information  or  to 
obtain  a copy  of  this  report,  please 
contact  the  Injury  Prevention  and 
Control  Program,  Division  of  Preven- 
tion Programs,  Colorado  Department 
of  Health,  PPD-1  P-A5,  4300  Cherry 
Creek  Drive  South,  Denver,  CO 
80222-1  530,  phone  (303)  692-2586. 


Colorado  Medicine  for  May,  1993 


195 


lassified  Advertising 


Publication  of  any  advertisement  in  Colorado  Medicine  is  not  an  endorsement  by  the  Colorado  Medical  Society 
of  the  product  or  service.  Colorado  Medicine  magazine  is  the  official  journal  of  the  Colorado  Medical  Society,  and 
is  authorized  to  carry  General  Advertising. 


♦ PROFESSIONAL  OPPORTUNITIES 


O'CONNOR  & ASSOCIATES— Medical 
Management  Consulting.  Services 
include:  free  initial  consultation, 
financial,  personnel  and  contract 
management;  planning  & implementing. 
William  J.  O'Connor,  PhD,  7436  S. 
Clarkson  Cir.  Littleton,  CO  801 22  (303) 
797-8611  1/0593 


EMERGENT/URGENT  CARE  PHYSICIAN 
Full  and  part  time  position  in  Lafayette. 
Flexible  scheduling.  Send  CV  or  Contact 
Dr.  Coryell,  Community  Medical  Center, 
2000  W.  S.  Boulder  Rd.,  Lafayette,  CO 
80206,  (303)  666-4357.  1 2/0892 

CRAIG  - Northwest  Colorado  three  person 
Family  Practice  partnership  seeks  a fourth 
BC/BE  Family  Physician.  Practice  includes 
OB  and  Pediatrics...  Excellent  lifestyle, 
outdoor  activities  are  unlimited  and  a 
progressive  growing  hospital  and  medical 
community  awaits  the  right  individual. 
Contact  L.  Kipe,  M.D.  or  A.  Huffmire,  M.D. 
303-824-3252  or  303-824-2122.  3/0593 

INTERNAL  MEDICINE  PARTNER  NEEDED- 
in  Loveland,  Colorado.  Established  3- 
Doctor  clinic  in  Loveland,  CO.  Population 
38,000.  Modern  1 1 0-bed  hospital  with  sub- 
specialty coverage.  One  hour  north  of 
Denver.  Situated  between  three  largercities. 
Beautiful  surroundings  and  recreational 
activity.  Excellent  school  system.  Great 
opportunity  at  the  foot  of  the  Rockies. 
Contact  Dr.  Tello  at  (303)  667-3565. 

2/0593 

LOCUM  TENENS...  new  adventures,  free 
from  administrative  tasks,  flexibility,  and 
high  earnings.  Assignments  vary:  one  day, 
one  week,  one  month,  long  term,  OR,  time 
off  with  peace  of  mind,  knowing  that  your 
practice  goes  uninterrupted.  Qualified 
physicians  are  ready  to  assist.  Ten  years 
experience;  physician-managed  company. 
Call  INTERIM  PHYSICIANS  today  for 
details. — Denver691  -071 8,  or  1 -800-669- 
0718  12/1292 


TIRED  OF  THE  DAY  TO  DAY  HASSLE  of 

HMO's,  Medicare,  discounted  insurance 
and  being  on  cal  I?  Then  consider  a position 
with  Corrections.  Before  you  say  "No  Way," 
call  us  and  find  out  more.  Contact  Roderic 
Gottula,  MD,  10900  Smith  Road,  Denver, 
CO  80239  or  call  (303)  375-21 1 0.6/01 93 

BOULDER- AMBULATORYCARECLINIC- 
Family  Medicine/Emergent  Care/Occu- 
pational Medicine  - Busy,  two  physician 
practice  seeking  full  time  BE/BC  Family 
Practitioner  to  join  growing  comprehensive 
medical  practice  in  prime  SE  Boulder  area. 
New,  well  equipped  facility.  Minimal  call. 
Flexible  scheduling.  Send  CV  and  call  Dr. 
Turnbow,  4800  Baseline,  D-1 06,  Boulder, 
Co  80303  (303)  449-4800.  3/0593 

PHYSICIANS,  SURGICAL/ANESTHES- 
IOLOGY RESIDENTS,  (MD/DO).  Ex- 
ceptional part-time  practice.  Colorado  and 
Nationwide.  Outstanding  fringes,  educ. 
assistance.  Air  National  Guard.  Call  Edd 
(307)  772-6185.  9/0293 

OPPORTUNITY  FOR  EMPLOYMENT,  part 
time  or  full  time  in  an  outpatient  Rectal 
Clinic  in  Denver,  Colorado.  For  information: 
Joseph  J.  Major,  D.O.,  P.C.,  FACOS.  651 
Potomac  - Suite  C,  Aurora,  CO.  80011- 
Phone; 303-344-8274.  1/0593 

DIAGNOSTIC  RADIOLOGY  - Immediate 
opening  for  part-time  work  as  a General 
Diagnostic  Radiologist  in  a hospital  based 
practice,  30  minutes  north  of  Denver,  in  a 
pleasant,  state-of  the-art  radiology 
department.  Send  CV  to  Diagnostic 
Radiology  Physicians  P.C.,  1960  Altura 
Blvd.,  Aurora,  CO  8001 1 . 3/0493 

UNCLE  SAM  IS  WILLING-  Would  up  to 
$50,000  a year  for  life  in  Retirement  Benefits 
- paid  in  full  in  10  years-  with  dollars  you 
are  now  paying  to  Uncle  Sam  be  of  any 
help  to  you?  We  have  the  program,  all  we 
need  is  you.  Call  H.A.  Kline  (303)  850- 
9775.  2/0593 


PART  TIME/FULL  TIME  BE/BC  Pediatrician 
needed  for  busy  pediatric  practice  in  S.E. 
Denver.  Send  CV  to  Box  V.  C/O  Colorado 
Medical  Society.  2/0593 

OCCUPATIONAL  MEDICINE-  Private 
practice,  3-4  days  per  week-  reasonable 
patient  load  - no  billing/no  hassles.  Good 
salary,  commensurate  with  experience. 
Long-term  opportunity  for  partnership  with 
right  person.  Call  Dr.  Shure  at  831-9393. 
3/0593 

♦ PROPERTIES  FOR  SALE  OR  LEASE 

Professional  Office  Space 

Excellent  location  in  Wash  Park/DU  area. 
Share  common  pt.  waiting  room  w/  2 
internists  and  1 DDS.  Three  1 0’  X 1 01  ops, 
reception  area.  Very  reasonable.  Call  Russ, 
688-8976.  12/0792 

J EWELL  & WADSWORTH- Retail/ofc  space 
for  lease  - excel  lent  exposure  - free  standing 
building  - 2000  square  feet  $1  375/month. 
Tenant  finish  $$  available.  Call  Billy  Halax 
973-1380  6/0593 

MAUI,  HAWAII.  Luxurious  2BR/2BA, 
2,100  sq.ft,  condominium  in  Kaanapali 
Beach  Resort,  100  yards  from  beach. 
Everything's  new!  Pool,  Jacuzzi,  Sauna, 
Lighted  Tennis  Courts,  Maids.  On  16th 
fairway  of  the  Royal  Kaanapali  Golf  Club. 
Special  Spring/Summer  Rates.  Call  985- 
9531.  6/0393 

FOR  SALE:  Medical  Office  Building  located 
in  the  beautiful  Mtn.  community  of 
Woodland  Park,  Co.  18  Mi.  to  Colorado 
Springs  and  25  Mi.  to  Cripple  Creek.  Sale 
necessary  due  to  husband's  death.  For 
information  contact  Mrs.  R.  ].  Groeger — 
1 21 0 W.  Lorraine  Woodland  Park,  Co.  or 
call  (719)  687-2687.  6/0293 

FOR  SALE:  2 Bedroom.  2 bath,  beachfront 
MAUI  condo,  flexible  time  share,  1 week 
even  years.  Fee  simple.  For  details  call 
(303)278-1388.  2/0593 


196 


Colorado  Medicine  for  May,  1993 


Classified 


♦ EQUIPMENT  FOR  SALE  OR  LEASE 

FOR  SALE — Complete  office  automation 
system.  AMS  Practice  Plus  multi-use  work 
station.  Includes  two  386  computers, 
internal  modem,  VGA  monitors,  brand  new 
24-pin  printer,  LAN  setup  and  all  software. 
Support  system  and  license  transferred  to 
new  owner  at  no  charge.  Asking  $7,500 
(software  alone  worth  $7,000.  Call  Beverly 
at  (303)  842-5503.  1/0593 

BUY  DIRECT— LOCAL  MFGR.  Custom 
Office  Furniture — Desks,  Credenzas, 
bookcases,  Files,  work  stations,  waiting 
room  seating,  etc.  Oak-cherry  & walnut. 
We  build  quality  custom  office  furniture  at 
a price  you  can  afford.  Mark  IV  Systems, 
Inc.  297-1 248.  8:00-4:30  M-F.  1 2/0293 

FOR  SALE:  Multiple-station  Pulmonary 
Function  Testing  System.  Twenty  office- 
based  spirometry  units  with  volume 
spirometer,  computer  workstation,  cali- 
bration syringe  and  modem.  Central 
computer  facility  with  storage,  modems 
and  printer.  May  be  acquired  with  existing 
accounts  on  contract  to  provide  pulmon- 
ologist overread.  All  offers  will  be 
considered.  For  more  information,  contact: 
Peter  Canaday,  M.D.,  Western  Pulmonary 
Services,  501  S.  Cherry  St.  #700,  Denver, 
CO  80222.  (303)  892-0547.  3/0593 

♦ PRACTICES  FOR  SALE 

BUSY  X-RAY/MAMMO  DEPT,  for  sale  in 
Thornton,  CO.  For  more  information  call 
Bobbie  at  (303)  252-0083. 

♦ SERVICES 

QUICK  CLAIM  ELECTRONIC  CLAIMS 
PROCESSORS,  HMO  PPO,  MEDICARE, 
MEDICAID  AND  PATIENTS  BILLING  (303) 
333-8666.  22/0393 

INNOVATIONS  SHOULD  BE  PATENTED 

if  marketable.  For  more  information  call 
Brian  D.  Smith  of  Fields,  Lewis,  Pittenger  & 
Rost.  Colo's  leading  patent  law  firm.  Mr. 
Smith  specializes  in  the  medical  arts.  (303) 
758-8400.  12/1192 


MEDICAL  LITERATURE  RESEARCH  - 
Want  to  review  literature  for  clinical  or 
legal  problems,  presentation  or  publication!1 
Experienced  physic  ian/author/educator  will 
do  customized  multiple  database  search  at 
reasonable  rates.  Call:  Bill  Milburn,  MD  at 
823-5083;  1-800-828-9259  (outside 
Boulder/Longmont).  12/0792 

HOME  MORTGAGE  LOANS 
LOW  DOC  PROGRAM  available  for 
physicians  and  other  health  professionals. 
Purchase  and  refinance.  Call  Milt,  a 
mortgage  banker  with  1 8 years  experience. 
753-6262.  12/1292 


Cash  Crunch? 

Overhead  Rising? 

Revenue  Dropping? 

Let  us  help  lower  your  costs.  YOU 
specialize  in  patient  care.  WE  specialize 
in  insurance  billing.  We  work  with 
Medicare,  Medicaid,  HMO's,  PPO's, 
and  other  third  party  carriers. 

We  don't  get  paid  until  you  get  paid. 
For  more  information  call  Advanced 
Professional  Services  (303)  755-0093. 

tfn/0492 


Practice  Valuations  $389  - Includes 
accounts  receivable,  medical  and  office 
equipment  and  furniture.  Call  Yvonne,  3- 
Minute  Reader  (1-800-848-4912  x-4401 
or  Denver  metro  756-6108.  Out-of-metro 
include  travel  expenses.  4/0393 

174-PAGE  OSHA  MANUAL  customized 
for  your  office  to  meet  cu  rrent  requ  i rements. 
$175.  JCE  Publications,  6025  Delmonico 
Drive,  Colorado  Springs,  CO  80919  (719) 
590-1177.  1/0593 

♦ MISCELLANEOUS 

EQUIPMENT  NEEDED  URGENTLY  for 

large  community  health  center  located  in 
Longmont.  Our  five-exam  room  facility 
will  soon  expand  to  1 2 exam  rooms  and  we 
are  looking  for  good  used  office  equipment 
and  exam  room  furnishings.  Call  to  discuss 
price/donations  with  Mark  Kissack  at  (800) 
388-4325.  6/0393 

PHYSICIANS  & THEIR  FAMILIES  WORK- 
SHOP: July  25-30,  Location:  Grande  Butte 
Hotel,  Crested  Butte,  CO.  Credit:  The 
Menninger  Clinic,  Topeka,  KS,  800-288- 
7377.  1/0593 


Fighting  Allergies 
_ is  no  place 
for  amateurs. 

Serious  allergies  require  serious  care  - the  kind  that  only  well-trained  professionals  can 
provide.  But  if  we’re  going  to  knock-out  allergies,  we  need  team  work!  That’s  where  the 
Asthma  and  Allergy  Foundation  of  America  can  help. 

We’re  dedicated  to  helping  you  help  your  patients.  We  offer  a toll-free  patient  information 
number,  a full  range  of  educational  materials  for  adults  and  children  and  special  school  and 
community  programs.  Plus,  we  can  put  them  in  touch  with  our  nationwide  network  of  chapters 
and  support  groups. 

Let  us  help  you  win  the  fight!  We’ve  been  serving  asthma  and  allergy  sufferers  for  more 
than  40  years.  For  more  information  about  our  services  or  professional  memberships,  call  us 
today. 

ASTHMA  & ALLERGY  FOUNDATION  OF  AMERICA 

1125  15th  St  NW  Suite  502 
Washington  DC  20005 

1-800-7  ASTHMA 


Colorado  Medicine  tor  May,  1993 


197 


U M I N AT  I O N S 


(def:  chewing  again  what  has  been  chewed  slightly  and  swallowed;  REFLECTIONS) 


by  Bill  Pierson,  Managing  Editor 


"You're  in  a balloon!" 


When  I hear  about  economists 
getting  involved  with  health  care 
cost  containment  and  cost  control  I 
remember  one  of  my  favorite  stories. 
It  was  an  economist  who  told  me  the 
story,  so  I feel  I can  repeat  it  here. 

Names,  places  and  nomencla- 
ture have  been  changed  to  protect 
the  innocent. 

Two  young  doctors  were  pursu- 
ing their  free  time  hobby  of  hot  air 
ballooning  and  they  were  riding  the 
currents  having  a fine  time.  Sud- 
denly, they  found  themselves  totally 
isolated  from  earth  and  all  living 
things.  They  were  in  a cloud.  Soon, 
this  became  a heavy  overcast  and 
they  started  to  become  alarmed.  The 
doctor  with  the  greater  piloting 
experience  said  not  to  worry;  they 
would  come  to  a clearing  and  be 
able  to  find  a landmark  to  know 
where  they  were. 

Finally,  the  balloon  basket  did 
break  into  the  open  and  below  the 
doctors  saw  a railroad  track.  The 
pilot  steered  the  balloon  along  the 
track  hoping  to  come  to  an  identifi- 
able crossing  or  some  such  thing. 
Their  good  fortune  held  on  long 
enough  for  a country  station  house  to 
come  into  view  and  there  was  one 
person,  a man,  standing  on  the 
station  platform.  The  pilot  steered  the 
balloon  as  close  to  ground  as 
possible  and  he  yelled  out  over  the 
basket  edge:  "Sir!  Can  you  tell  us 
where  we  are?"  The  man  looked  for 
a long  moment  and  then  replied, 
"You're  in  a balloon!"  No  sooner 
than  he  had  said  this  than  the 
overcast  closed  in  and  the  pilot  had 
to  give  the  balloon  the  gas. 

The  passenger  doctor  said  "That 
sure  helped  a lot."  But  the  doctor 
pilot  replied  "Well,  maybe  not,  but  I 
know  the  guy's  an  economist." 


"How  could  you  tell  that?"  asked  the 
second  doctor.  The  doctor-pilot  said 
"Simple.  Everything  he  said  was 
true...  but  totally  irrelevant." 

Moral:  Find  out  who  you  are  asking 
before  you  ask.  There  may  not  be 
another  break  in  the  clouds. 

By  the  way.  . . I forgot  to  mention 

last  month  why  I had  the  picture  of 
the  monogrammed  towel. 

While  trying  to  find  an  appropri- 
ate identifier  for  health  care  reform 
stories,  a sort  of  logo,  I was  playing 
around  with  key  letters.  I started 
putting  them  together  in  a typical 
fashion,  such  as  "HCR".  Quite  by 
accident  I noticed  that  when  they 
were  displayed  in  one  manner  they 

resembled  monograms,  and 

SUDDENLY  the  whole  health  care 
reform  symbol  became  a monogram 
for  Hillary  Rodham  Clinton. 

Just  think:  health  care  reform 
may  be  hanging  in  every  bathroom 
in  the  White  House;  all  sorts  of 
people  using  health  care  reform  for 
who  knows  what. 


Monogrammed  towel  said  to  have 
been  seen  in  the  White  House. 


198 


Colorado  Medicine  for  May,  1993 


HEALTH  sciences  library 
UNIVERSITY  OF  MARYLAND 

BALTIMORE 


Jut  2 m 


REC'O. 


Ill  If!  H 


H H 


Volume  90,  Number  6 


COLORADO  MEDICAL  SOCIETY 
TENTATIVE  1993  Annual  Meeting  Schedule 
Snowmass  Village,  CO 
September  9-1 2,  1993 


Thursday,  Sept.  9 

9:00  am 


2:00  N 4:00  pm 

1 :00  pm  — 2:30  pm 

2:30  pm 1:30  pm 

3:00  pm— -6:00  pm 
5:00  pm  -10:00  pm 
6:00  pm— -7:00  pm 

7:00  pm — 8:30  pm 


18-hole  Golf  Tournament- 
Aspen  Country  Club 
Arrange  Exhibit  Hall 
Finance  Committee 
Board  of  Directors 
CMS  Office  open 
Exhibitor  Set  Up 
Reception:  It's  a Jungle  Out 
There 

Dinner:  It's  a Jungle  Out  There 


NOTE : Dress  for  Annual  Meeting — 

Thursday  evening  reception/dinner:  lungle  safari 
or  casual 

Friday:  business  attire 

Saturday  morning:  casual 

Saturday  reception/dinner:  coat  and  tie/dressy 

business  attire  or  cocktail  dress 

Sunday: casual 


Friday,  Sept.  1 0 

7:00  am 

7:00  am— -5:00  pm 
7:15  am  — 8:45  am 
7:15  am  — 8:45  am 
7:30  am  —8:30  am 
8:00  am  -12:00  N 
8:30  am — 9:00  am 
8:30  am  -10:00  am 
9:00  am — 9:30  am 
9:30  am  -11 :45  am 
10:00  am  -10:30  am 
10:15  am  -11:45  am 

12:00  N 1:30  pm 

12:00  N 1:30  pm 

1 :30  pm  — 1 :40  pm 
1 :30  pm  — 7:00  pm 
1:30  pm  — 2:30  pm 
1 :30  pm — 4:00  pm 
1:30  pm — 4:00  pm 
2:30  pm  — 3:30  pm 
3:30  pm — 6:00  pm 
330  pm — 6:00  pm 


CMS  Office  opens 
Registration 

Congress  of  Medical  Specialties 
El  Paso  County  Caucus 
Reference  Cmte.  Breakfast 
Exhibits  open 
Credentials  Committee 
CMSA  BOD  Breakfast 
Opening  Session  - HOD 
General  Membership  Meeting 
Coffee  break 
CMSA  General  Meeting 
COMPAC/CMSA  Luncheon 
Physician/Patient  Advocacy 
Council 

COMPAC  General  Membership 
Exhibits  open  (refreshments) 
Copic  Risk  Management 
Reference  Committee 
Reference  Committee 
Copic  Risk  Management 
Reference  Committee 
Reference  Committee 


5:30  pm— -7:00  pm  Exhibitor  Reception 
6:30  pm— -7:30  pm  Colorado  Society  of  Internal 
Medicine  Annual  Meeting 

6:30  pm  — 7:30  pm  Women  in  Medicine  Reception 
7:00  pm— -8:30  pm  "Gone  But  Not  Forgotten" 
Dinner 


Saturday,  Sept.  1 1 

7 :00  am CMS  Office  opens 

7:00  am  — 1 :30  pm  Registration 
7:00  am  — 7:50  am  Educ.  Prog.  Cont.  Breakfast 
7:00  am  - 1 2:00  pm  Exhibits  open 
8:00  am  -12:30  pm  Educational  Program  Survival 
Techniques  in  the  Health  Care 
Jungle 

12:30  pm  Recreational  Activities 

(golf,  tennis,  horseback  riding,  biking,  fishing, 
walking,  etc.)  Great  Outdoors!! 

5:00  pm— 6:00  pm  Cash  Bar 
6:00  pm  — 7:00  pm  Inaugural  Address 
7:00  pm  - 1 1 :30  pm  Presidents'  Dinner/Dance 
8:30  pm  - 1 1 :30  pm  Copic  Dessert  Reception 
Sunday,  Sept.  1 2 

6:30  am Ref.  Cmte  Reports  available 

7 :00  am CMS  Office  opens 

7:00  am  - 1 2:00  N Registration 

7:00  am  — 8:30  am  Component  Caucuses 

Arapahoe 

Aurora-Adams 

Boulder 

— Clear  Creek  Valley 

Denver 

El  Paso 

Larimer/Weld 

Pueblo/Western  Slope 

8:00  am  -—8:30  am  Credentials  Committee 
8:00  am  -—9:00  am  CMSA  Gavel  Club  Breakfast 
8:30  am  -12:00  N Closing  Session  HOD 
9:00  am  - 1 1 :00  am  CMSA  Program 
12:00  N (or  immediately  following  HOD) 

Nominating  Committee 

12:00  N (or  immediately  following  HOD) 

Reorganizational  Board 


1 


When  You  Shop  For 
Malpractice  Insurance, 
Low  Bid  Doesn’t  Ahvajs  Give 
You  The  Real  Bottom  Line 


Chances  are,  if  a Colorado  physician,  or  a medical  manager,  comparison  shops 
for  malpractice  insurance,  Copic  Insurance  Company  will  offer  the  best  price, 
when  all  of  the  discounts  and  dividends  are  sorted  out.  ♦(*  Even  so,  low  bid 
doesn’t  give  you  the  real  bottom  line.  If  responsiveness  to  policyholder  needs 
and  many-faceted  contributions  to  the  Colorado  physician  community  are 
factored  in.  Copies  out  - of-  state  competitors  can’t  even  come  close.  ♦>  Besides, 
low  bid  could  carry  a very  high  price  if  - as  happened  a few  years  ago  - Copic’s 
competitors  drop  Colorado  like  a hot  potato  and  flee  the  state  when  the  going 
gets  rough,  or  when  the  process  server  drops  the  summons  or  subpoena, 
v Copic’s  here  to  stay.  And,  our  damage  control  and  legal  defense  teams  are 
the  best  in  the  business. 


The  Copic  Bottom  Line. 

It’s  more  than  just  competitive  rates. 


p n Copic  Insurance  Company 

U‘  Box  17540  • Denver,  CO  80217-0540  • (303)779-0044  • 1-800-421-1834 


Tentative  Annual  Meeting  Registration 

1993  Annual  Meeting  of  the  Colorado  Medical  Society,  September  9-12,  1993,  Snowmass  Conference  Center 

Name  (please  print) 

Name  of  Spouse/Guest  (s)  (if  attending) 

Component  Society office  Phone 


Please  check  all  that  apply 

□ Women  in  Medicine 

□ Young  Physicians 

□ Resident  Physicians 

Section 

Section 

Section 

□ Component  Society 

□ Program  Speaker 

□ Press 

□ Other 

Executive 

If  you  are  not  a member  of  CMS,  please  provide  the  following: 

Company/Organization Title 


Reservations  for  Events  and  Meetings 

Reservation  deadline  is  August  27,  1993.  Reservations  accepted  on  a first-come,  first-served  basis  (may  be  limited 
for  some  programs).  For  purposes  of  registration,  staff  of  county  medical  societies  are  considered  members.  Please 
indicate  the  number  of  attendees  for  each  function,  even  if  there  is  no  charge,  so  that  we  may  be  cost  efficient  with 
food/beverage  orders. 

As  a member,  you  and  one  guest  are  entitled  to  attend  the  complimentary  events  at  no  charge.  Please  indicate 
the  number  oi  additional  guests  at  the  bottom  of  this  form  and  enclose  your  check. 


Complimentary  events  open  to  all  members: 

Thursday,  September  9 

6:00  pm  Reception:  It's  a Jungle  Out  There 
7:00  pm  Dinner:  It's  a Jungle  Out  There 
Friday,  September  10 

5:30  pm  Exhibitor  Reception 

6:30  pm  Women  in  Medicine  Reception 

Saturday,  September  1 1 

7:00  am  Educational  Program  Continental  Breakfast 

8:00  am  Educational  Program 

7 :00  pm  President's  Dinner  Dance  (please  select  menu  below) 
Beef  Dinner 
Chicken  Dinner 

8:30  pm  Copic  Dessert  Reception 


member 

member 

member 

member 

member 

member 


a 

a 

a 


member  □ 
member  LJ 
member  Ll 


guest  □ 
guest  U 

guest  □ 
guest  U 

guest  □ 
guest  U 

guest  □ 
guest  LJ 
guest  U 


Non-Complimentary  Events:  Cost  Number 

Friday,  September  10 

8:30  am  CMSA  BOD  Breakfast $12  each  

12  Noon  COMPAC/CMSA  Luncheon $15  each  

Total  for  Non-Complimentary  Reservations  $ 

Additional  Reservations  (other  than  member  + 1 guest): 

Reception:  It's  a Jungle  Out  There  # ©$10each=  

Dinner:  It's  a Jungle  Out  There  # @525  each=  

Educational  Program  Breakfast  # ©$15each=  

President's  Dinner  Dance  (please  select  menu  below) 

Beef  Dinner  # ©$40  each=  

Chicken  Dinner  # ®$40  each=  _ 


Total  for  Additional  Reservations  $ 


Total  enclosed  for  non-complimentary  and/or  additional  reservations $ 


Cpic 


Comment 


Colorado  Supreme  Court  supports  the  constitutionality  of  challenged  portions  of 
Health  Care  Availability  Act 


long  and  anxiously 
awaited  by  both  defense  and 
plaintiff  bars,  the  Colorado  Su- 
preme Court  on  26  April  1993 
placed  its  imprimatur  of  constitu- 
tionality on  several  major  provi- 
sions of  1 988's  SB-1 43,  the  Health 
Care  Availability  Act  (HCAA), 
legislation  brought  to  successful 
enactment  largely  through  coopera- 
tive efforts  of  organized  medicine 
and  Copic. 

In  its  opinion,  the  unanimous 
court  specifically  ruled: 

1 . Provisions  of  HCAA  are  appli- 
cable to  the  unlicensed  parapro- 
fessional  employees  of  physi- 
cians. 

2.  The  HCAA  is  constitutional 
because  its: 

a.  Damages  provision  limiting  non- 
economic damages  to  $250,000 
does  not  limit  a plaintiff's  right  to 
jury  trial,  since  the  Colorado 


Constitution  does  not  create  a 
"right"  to  jury  trial  in  civil 
matters. 

b.  Damages  limitations  do  not 
violate  the  right  to  equal  protec- 
tion of  the  laws;  applying  the 
rational  basis  test  the  court  found 
the  statute  reasonable  and 
bearing  a rational  relationship  to 
a legitimate  state  objective — the 
effort  to  increase  the  availability 
of  health  care  to  Colorado 
citizens. 

c.  Damages  limitations  do  not 
violate  the  right  to  due  process 
of  the  laws;  the  constitutional 
guarantee  is  applicable  to  rights, 
not  remedies. 

3.  Further,  the  limitation  of  non- 
economic damages  to  $250,000 
was  upheld  and  given  effect  over 
older  statutes,  the  court  noting 
that  HCAA  was  later  enacted 
than  1986  statutes  which 


permitted  a court  to  increase 
that  figure  to  $500,000. 

The  Court's  opinion  includes  the 
ruling  that  prejudgment  interest  is 
calculated  on  both  past  and  future 
damages;  Justice  Lohr,  dissenting 
only  on  this  portion  of  the  opinion, 
disagrees.  Additionally,  the  opinion 
decrees  that  the  HCAA  damages 
cap  at  $1,000,000  does  not  include 
prejudgment  interest,  thereby 
permitting  certain  recoveries  to  go 
above  the  S 1 million  figure  when 
interest  is  added  to  compensatory 
damages. 

While  not  perfect  in  doing  what 
we  had  hoped  for,  the  opinion 
lends  strong  constitutional  credibil- 
ity to  the  elements  of  HCAA,  in  an 
opinion  delivered  almost  exactly 
five  years  after  legislative  enact- 
ment—about  one-half  the  time 
require  for  California's  MICRA  to 
pass  constitutional  muster  at  the 
appellate  court  level. 


Bring  the  Whole  Family 


While  you're  in  Snowmass  for  the  meeting, 
would  include  not  only  golf,  but  tennis,  hot 
rides,  white  water  and  calm  water 
rafting,  trout  fishing,  horseback  riding 
and  even  llama  treks  in  the  nearby 
White  River  National  Forest. 

In  addition  to  the  many  whole- 
some activities  already  available  in 
the  Snowmass  area,  the  Resort 
Association  will  be  providing  a 
special  family  package  of  activities. 

While  you  are  in  the  meetings, 
licensed  day  care  personnel  will  take 
your  children  to  Maroon  Bells,  on 
various  hikes  and  to  other  points  of 
interest  in  the  vicinity.  This  package  is 
available  for  children  up  to  age  1 4 at 
$40  per  day  (including  lunch)  or  $20 
for  an  evening.  Call  Jane  Finsterwald 
at  the  Snowmass  Resort  Association  at 
923-2000  for  more  information. 


don't  neglect  the  many  other  activities  that  are  available.  A partial  listing 
ballooning,  downhill  mountain  biking,  jeep  trips  and  tours,  gondola 


In  addition  to  outdoor  activities,  the  Snowmass 
of  dining  experiences.  The  following  is  a list  of 

Brother's  Grille 

Chez  Grandmere 

Cowboy's 

Hue's 

Krabloomk 

La  Pmata 

La  Boheme 

Mayfair  Deli 

Moon  Dogs 

Mountain  Dragon  

Paradise  Bakery 

Pipiim's 

Pour  La  France 

Rocky  Mountain  Choc.  Factory 

S'no  Beach  Cafe/Snowmass  Sushi 

Stew  Pot 

The  Four  Corners  Grill  (SLC) 

Timberline 

Timbermill 

Tower 


area  offers  a wide  variet 
area  restaurants: 
.932-3520 
.923-2570 
.923-5249 
.923-2748 
.923-4292 
.932-2153 
923-6804 
923-5938 
.923-6655 
-923-3576 
.923-4712 
.923-2073 
•923-5990 
923-2875 
-923-2597 
923-2263 
923-5600 
92.3-4004 
-923-4774 
923-4650 


Colorado 

June,  1993 


Medicine 

Volume  90,  Number  6 


In  This  Issue... 

Enjoy  a great  weekend  in 
the  outdoors  with  your  family 
and  accomplish  the  business 
of  organized  medicine  at  the 
same  time. 

The  123rd  Annual  Meeting  of 
the  Colorado  Medical  Society  is  a 
great  opportunity  to  demonstrate 
your  commitment  to  the  best 
interests  of  your  patients  by  joining 
fellow  medical  professionals  to 
formulate  our  corporate  policies  and 
actions  for  the  coming  year. 

In  addition,  we  have  provided 
many  varied  activities  for  you  to 
enjoy  with  your  family,  or  for  them 
to  enjoy  while  you  are  in  the  meet- 
ings. Look  inside  for  a special 
program  designed  just  for  those  1 4 
and  under. 


September  in  Snowmass,  Colorado 

* by  Gil  Maestas,  II 

Comm  un  i cat  ions  Sped  a list 


The  123rd  Annual  meeting  of  the 
Colorado  Medical  Society  will  be 
held  September  9th  thru  1 2th  in  the 
beautiful  Colorado  Rockies  at  the 
Snowmass  Conference  Center. 

The  Snowmass  area  offers  a 
peaceful  setting  as  well  as  clean  air 
and  crystal  clear  skies  in  which 
members  may  conduct  business  as 
well  as  catch  up  on  the  events  of  '92 


with  colleagues.  . . . 

The  Snowmass  area  offers  a wide  assortment  of  outdoor  activities  from 
mild  to  wild.  Floating  on  a raft  down  a white  water  river  is  one  of  the  best 
ways  to  take  in  the  beauty  of  Colorado's  magnificent  landscape.  Beginners 
can  experience  a gentle  trip  down  the  Colorado  River,  through  the  breathtak- 
ing Glenwood  Canyon,  while  the  more  adventuresome  rafter  will  prefer  the 
challenge  of  mastering  the  Arkansas  River's 
exciting  rapids.  If  water  is  not  your  forte  there 
are  bicycle  tours,  trail  blazing  in  4WD  vehicles 
as  well  as  numerous  hiking  adventures.  The 
only  limit  on  how  you  spend  your  time  is 
imagination.  For  more  information  on  the 
activities  mentioned  call  Blazing  Adventures  at 
1 -(303)  923-4544  and  ask  to  speak  with  Renee 
for  group  information. 

We  hope  that  your  stay  in  Snowmass  will 
be  an  enjoyable  experience.  If  we  can  help  in 
any  way  please  don't  hesitate  to  ask. 

For  more  information  please  contact  Sandy 
Finney  at  the  Colorado  Medical  Society,  (303) 

779-5455  (ext.  406). 


- P'e,S°n'  Man"'°';  “ Th"m,KOn- ** CM  Maestas,  ns  


(s  *,'*fn**f'  Colorado  Pre«  Aijocialicn, 


lo  Colofido  Broadcaster,  Aiiociaion 


Growth  Comes 
From  the  Roots 


Leigh  Truitt,  MD, 


Sandra  L.  Maloney 
Executive  Director 
Colorado  Medical  Society 


erow  to'tlie  skv  When  tmoc  a ' mm~~  f CMS  Piesident,  recently  explained  why  trees  don't 
grow  to  the  sk^  When  trees  do  grow  strong,  however,  we  know  it  is  because  they  have  a good 

root  system  with  which  to  draw  water  and  nntrientc  • , y K 

w-  tv  Ym  m u nutrients.  The  same  is  true  of  YOUR  Colorado  Medical 

Society.  You,  our  members,  are  the  roots. 


Did  you  know  that  almost  everything  the  CMS  staff,  Councils,  Committees  and  Task  Forces  do  is 
detei  mined  by  resolutions  presented  at  the  meetings  of  the  House  of  Delegates?  Not  only  that,  but 
each  member  has  an  equal  opportunity  to  present  resolutions  for  consideration,  to  testify  before  a 
Reference  Committee  (or  even  serve  on  one)  and  to  have  a dramatic  impact  on  the  direction  CMS 
will  take  on  important  issues  in  the  coming  year.  The  Colorado  Medical  Society  really  is  a mem- 
ber driven  organization. 

We  have  lots  of  educational  and  fun  activities  scheduled  for  you  this  year,  in  addition  to  the 
business  meetings  that  set  CMS  policy  and  drive  all  our  activities  for  the  year. 


Look  over  the  enclosed  information,  select  those  activities  and  meetings  in  which  you  would  like 
to  participate  and  fill  in  your  registration  form.  You  then  may  mail  it  to  us  (at  PO  Box  1 7550, 
Denver,  CO  8021  7-0550),  phone  it  to  us  (at  303/779-5455)  or  even  FAX  it  to  us  (at  303/771  - 
8657).  „ '7 

Get  your  registration  in  quickly.  There  are  limited  spaces  available  for  some  programs.  Notice 
also  that  you  will  need  tickets  for  all  meal  functions.  We  must  remain  fiscally  responsible  by 
getting  an  accurate  count  of  those  who  will  attend  these  functions. 

I look  forward  to  seeing  you  in  Snowmass! 


Sandra  L.  Maloney 


CMS  Annual  Meeting  Golf  Tournament 

at  The  Snowmass  Club 
Thursday,  September  9,  1993 
Entry  Form 


Name 


Address 

Please  give  us  the  following  information  for  tee  times  and  emergencies 


Office  Phone Home  Phone 

While  at  Snowmass  I will  be  staying  at 


FAX#  

(Needed  for  tee  times) 


I will  be  attending  the  meeting  in  the  capacity  of  (check  one) 

□ Physician  O Exhibitor  O Spouse  O Other 

I will:  O Sponsor  a golf  course  hole  @$100  □ Sponsor  a putting  green  contest  hole  @$50 

Name  of  sponsor  (as  you  wish  it  to  appear  on  sign)  

(Professionally  made  signs  will  be  displayed  for  sponsors.  All  proceeds  will  directly  benefit  the  CMS  Medical  Indigence  Program) 


My  golf  handicap  is □ USGA  O Other 

I will  require  rental  clubs  @ $1  8 O Left  handed  □ Right  handed 

Play  will  be  scramble  format.  Foursomes  will  be  arranged  according  to  various  levels  of  ability  by  the  golf  professional.  If  you 
have  a preference  of  who  you  are  teamed  with,  please  specify  below.  Prizes  will  be  awarded  for  a variety  of  categories  to  include 
closest  to  the  pin  and  longest  drive.  To  ensure  tournament  entry,  registration  form  and  advance  payment  of  $84  must  be  received 
no  later  than  August  16,  1993.  Cancellations  received  after  August  30,  1993  are  refundable  subject  to  ability  of  Snowmass  Resort 
Association  to  "resell"  vacated  tee  times. 

A shotgun  start  will  not  be  possible,  therefore,  please  be  prompt  with  your  tee  times.  To  reserve  personal  tee  times,  please  call 
the  Snowmass  Pro  Shop  at  923-3148. 

I prefer  to  be  teamed  with 

Mail  Entry  Form  and  check  for  $84  to  Specialty  Media,  P.  O.  Box  36357,  Denver,  CO  80236.  For  additional  information,  call 
Tim  Jackson  at  303-986-5926. 


Lodging  Reservation  Form 

Name  

Address  

City State Zip Daytime  phone  ( ) 

Total  in  party  Adults Children Ages  of  children  

□ This  is  to  confirm  phone  reservations 

Arrival  date  Departure  Date  

MC/Visa#  (if  appropriate) Exp.  date 

I wish  to  reserve:  (these  special  rates  apply  from  September  6-15,  1993) 

□ Silvertree  Hotel  Lodge  Room  ($98  per  night  for  2 persons,  each  additional  $15,  under  12  free) 

□ Mountain  Chalet  Lodge  Room  ($80  per  night  for  2 persons,  each  additional  $10,  under  12  free) 

Note:  Reservation  cut  off:  August  9, 1993.  One  night’s  lodging  required  as  deposit. 

CANCELLATION  POLICY : If  you  cancel  more  than  30  days  before  arrival  you  receive  full  refund,  less  $25  cancellation 
fee.  Thirty  days  or  fewer,  you  forfeit  one  night’s  rent,  or  $25  cancellation  fee  if  re-rented. 

Send  completed  Reservation  Form  to 
Snowmass  Resort  Association,  PO  Box  5566,  Snowmass  Village,  CO  81615 
Central  Reservations — (303)  923-2010  1-800-598-2004  (nation-wide) 


HEALTH  SCIENCES  LIBRARY 


UNIVERSITY  OF  MARYLAND 
BALTIMORE 


First  lady  speaks  to  the  AMA  House  of  Delegates 

(see  "AMA  UPDATE"  on  pg  224-225  with  overview  by  Dr.  Robert  McCartney) 


Jso  In  This  Issue: 

rom  Physician  to  Provider  to  Vendor  by  Leigh  Truitt,  M.D.,  President,  CMS pg  213 

Vashington,  D.  C.  "After  Dark"  by  Sandra  L.  Maloney,  Exec.  Dircetor,  CMS  pg  216 

t physician  legislator's  view  of  1993  - by  Pat  Sullivan,  M.D pg  220 

Medicine  in  the  Twenty-First  Century  by  Frederick  A.  Lewis,  Jr.,  M.D pg  234 

Vhat  they're  saying  about  "Enterprise  Liability"  Colorado  Medicine  interview  with 

Larry  Thrower,  President  of  Copic  Insurance  and  Physician  Insurers  Ass'n.  of  America pg  236 


Doctor,  Doctor! 
Come  Quick! 
There’s  a Process  Server 


in  the  Waiting  Room!’ 


An  unlikely  scenario?  Unfortunately,  no.  Colorado 
physicians  are  on  the  receiving  end  of  malpractice 
suits  on  the  average  of  once  every  seven  years. 
The  right  response?  Accept  the  summons 
or  subpoena,  then  pick  up  your  phone  and 
call  Copic  Insurance  Company  Headquarters, 
which  is  right  here  in  Colorado.  The  damage 
control  will  start  immediately,  and  you’ll 
feel  better  in  the  morning.  ❖ But,  you  say, 
what  if  the  targeted  physician  is  one  of  the 
minority  in  Colorado  who  didn’t  choose  Copic? 
Well,  maybe  he  or  she  won’t  feel  better  in  the  morning. 

The  Copic  Bottom  Line.  It’s  more  than  just  competitive  rates. 


(ope 


Copic  Insurance  Company 

PO.  Box  17540  • Denver,  CO  80217-0540  • (303)  779-0044  • 1-800-421-1834 


Colorado  Medicine 

July,  1993  Volume  90,  Number  7 


Cover  Story 


The  First  Lady  gives  the  AMA 
FHouse  of  Delegates  a teaser 
about  the  forthcoming 
Clinton  Health  Care  Reform 
program,  now  likely  to  be 
released  in  September. 


Departments 


213  President's  Letter 

216  Executive  Director's  Update 

218  The  Lobby 

222  Health  Care  Reform 

224  AMA  Update 

242  Medical  News 

246  Classified  Advertising 


n This  Issue... 


21  3 From  Physician  to  Provider  to  Vendor  - the  evolution  of 
"bulk  purchasing"  in  health  care 


by  Leigh  Truitt,  M.D. 

President 


216  A physician  legislator's  view  of  1 993 

by  Patrick  Sullivan,  M.D. 
Colorado  State  Representative 
Weld  County 

222  Health  Care  Reform  - a whole  new  side  of  organized 
medicine,  starting  with  the  introduction  of  newly- 
created  CMS  Health  Care  Reform  committee,  followed 
by: 

•The  First  Lady  & the  AMA 

by  Robert  McCartney,  M.D. 

• Report  to  the  Federation 

by  James  S.  Todd,  M.D.,  Executive  Vice  President 
American  Medical  Association 

• Comfortable  with  the  AMA's  "New  Partnership"  with 

the  Administration?  Better  take  a closer  look 

John  C.  Seiner,  M.D. 

• "Enterprise  Liability"  a new  wrinkle  in  Washington 

parlance  concerning  medical  liability  -opposed  by 
large  national  coalition 

• New  President  of  Physician  Insurers  Association  of 

America  responds  to  "Enterprise  Liability" 

Colorado  Medicine  interview  with 
Larry  Thrower,  President  & CEO  of  Copic, 
and  President  of  PIAA 


234  Medicine  in  the  Twenty-First  Century 

Frederick  A.  Lewis,  Jr.,  M.D. 

238  Colorado  Society  of  Internal  Medicine  surveys  members 
- first  and  only  demographic  collection  on  internal 
medicine  for  Colorado  in  1 993. 


240  People  to  People  trip  to  Viet  Nam  and  Southeast  Asia 

W.  Gerald  Rainer,  M.D. 


Colorado  Medical  Society 


COLORADO  MEDICAL  SOCIETY 
OFFICERS,  BOARD  MEMBERS  and  AMA  DELEGATES 


1992/1993  Officers 
Leigh  Truitt,  M.D. 

President 

Wm.  Carl  Bailey,  MD 

President-elect 

Terrance  J.  Sullivan,  M.D. 

Treasurer 

Stuart  O.  Silverberg,  M.D. 

Speaker  of  the  House 

David  C.  Martz,  M.D. 

Vice-speaker  of  the  House 

Sandra  L.  Maloney 

Secretary/Executive  Director 

Harrison  G.  Butler,  III,  M.D. 

(Immediate  Past  President) 


COLORADO  MEDICAL  SOCIETY  STAFF 


Board  of  Directors 

Board  of  Directors 

Thomas  J.  Allen,  MD 

Lothar  K.  Roller,  MD 

Stephen  G.  Batuello,  MD 

David  Shander,  MD 

John  O.  Cletcher,  Jr.,  MD 

W.  George  Shanks,  MD 

Donald  G.  Eckhoff,  MD 

Susan  A.  Sherman,  MD 

John  E.  Ell  iff,  MD 

Gary  D.  VanderArk,  MD 

Jonathan  C.  Feeney,  MD 

Denis  J.  Winder,  MD 

David  C.  S.  Franklin,  MD 

M.  Robert  Yakely,  MD 

Joel  M.  Karlin,  MD 

George  M.  Kreye,  MD 

AMA  Delegates 

Muryl  L.  Laman,  MD 

Ted  T.  Lewis,  MD 

M.  Ray  Painter,  Jr.,  MD 

Maura  J.  Lofaro,  MS  IV 

Richert  E.  Quinn,  Jr.,  MD 

Louise  L.  McDonald,  MD 

Mark  A.  Levine,  MD 

Robert  R.  Montgomery, 

Legal  Counsel 

Alternate  Delegates 

Robert  A.  Nathan,  MD 

Kenneth  M.  Olds,  MD 

Robert  D.  McCartney,  MD 

James  R.  Regan,  MD 

Robert  M.  Bogin,  MD 

Joel  M.  Karlin,  MD 

Executive  Office 

Sandra  L.  Maloney,  Executive  Director 
Mary  Lee  Johnston,  Executive  Admin.  Asst. 
Nancy  L.  Deter,  Manager,  Accounting 

Western  Slope  Office 

Dolores  M.  Bennett,  Executive  Secretary 

Division  of  Membership  Information  Services 

Timothy  H.  Roberts,  Director 
Diane  L.  LeHew,  Manager,  Support  Services 
Debra  M.  Jones,  Membership  Coordinator 
Beth  M.  Crusha,  Administrative  Assistant 


Division  of  Health  Care  Policy 

Ellen  J.  Stein,  Director 

Marilyn  P.  Barton,  Program  Manager 

Lynn  R.  Livingston,  Administrative  Assistant 

Division  of  Health  Care  Financing 

Edie  K.  Register,  Director 

Marijo  M.  Parkin,  Program  Manager 

Division  of  Government  Relations 

Sue  Ellen  Quam,  Director 

Lorraine  L.  Koehn,  Program  Manager/Lobbyist 

K.  Suzanne  Hamilton,  Administrative  Assistant 


Division  of  Professional  Services 

Sandra  M.  Finney,  Director 
Lorraine  K.  Heth,  Program  Manager 
Kirsten  E.  Regalado,  Secretary 


Division  of  Communications 

William  S.  Pierson,  Director 

Michael  P.  Thompson,  Communications  Spec. 

Gil  Maestas  II,  Communications  Staff 


COLORADO  MEDICINE  (ISSN-01 99-7343)  is  published  monthly  as  theofficialjournal  of  the  Colorado  Medical  Society,  7800  E.  Dorado  PI.,  Englewood,  CO  801 1 1 . Telephone  (303)  779-5455.  Outside 
Denver  area,  call  1 -800-654-5653.  Second  Class  postage  paid  at  Englewood,  Colorado,  and  at  additional  mailing  offices.  POSTMASTER,  send  address  changes  to  COLORADO  MEDICINE,  P.  O.  BOX 
1 7550,  Denver,  CO  8021 7-0550.  Address  all  correspondence  relating  to  subscriptions,  advertising  or  address  changes,  manuscripts,  organizational  and  other  news  items  regarding  the  editorial  content 
to  the  editorial  and  business  office.  Subscriptions  are  available  for  $30  per  year,  paid  in  advance. 

COLORADO  MEDICINE  magazine  is  the  official  journal  of  the  Colorado  Medical  Society,  but  as  such  is  also  authorized  to  carry  general  advertising.  Publicatipn  of  any  advertisement  in  COLORADO 
MEDICINE  does  not  imply  an  endorsement  or  sponsorship  by  the  Colorado  Medical  Society  of  the  product  or  service  advertised.  Published  articles  represent  opinions  of  the  authors  and  do  not  necessarily 
reflect  the  official  policy  of  the  Colorado  Medical  Society  unless  clearly  specified. 

Sandra  L.  Maloney,  Executive  Editor;  William  S.  Pierson,  Managing  Editor;  Michael  Thompson,  Asst.  Managing  Editor;  Gil  Maestas  II,  Communications  Specialist. 


Member,  Colorado  Press  Association, 


Member,  Colorado  Broadcasters  Association 


212 


Colorado  Medicine  for  July,  1993 


Photo  by  Rocky  Mountain  News 


Leigh  Truitt , MD 
President , 1992-93 


President's  Letter 

From  Physician  to  Provider  to  Vendor 


"Bulk  Purchasing " in 
health  care 

In  the  recent  past , many 
physicians  objected  to 
being  described  as 
providers  of  health  care. 

I recently  received  an 
application  from  Medi- 
care to  become  a vendor 
of  health  care  supplies. 
On  the  other  side , those 
who  pay  for  health  care 
are  saying  that  "[Bjulk 
purchasing  may  be 
inevitable. 


Eric  Berkowitz,  Ph.D.,  Professor  of 
Marketing  at  the  University  of 
Massachusetts  at  Amherst,  for 
example,  [says]  that  managed 
competition  is  not  so  much  a 
mechanism  that  will  totally  redirect 
the  system  but  rather  a catalyst  that 
may  speed  a trend  already  well 
under  way  toward  "bulk 
purchasing"  of  health  care.1 

Are  we  to  be  vendors  renting  our 
services  to  bulk  purchasers  of  health 
care?  Or  can  we  continue  to  be 
professionals  with  control  over  the 
terms  and  conditions  of  our  practice? 

I,  for  one,  continue  to  believe  in 
the  central  role  of  physicians  in 
providing  health  care  services  and 
also  in  managing  that  care.  We  are 
agreed  that  health  care  needs  more 
management  and  coordination  rather 
than  less.  Who  will  those  managers 
be? 

I often  hear  physicians  say  that 
they  "just  want  to  practice 
medicine"  or  "just  want  to  see 
patients".  If  all  physicians  truly  feel 
that  way,  we  will  all  be  for  rent  — 
employees  of  others,  whether  we  are 
reimbursed  by  fee-for-service, 
capitation,  or  salary.  At  the  same 
time,  I hear  physicians  complaining 
about  interference  with  their  practice 
and  with  physician/patient  relation- 
ships. We  frequently  express  dissatis- 
faction with  those  who  are  managing 
the  health  care  system  and  the  way 
that  system  operates. 

Perhaps,  we  are  confusing 
managers  with  leaders.  John  P. 
hotter,  Professor  of  Organizational 
Behavior  at  the  Harvard  Business 
School,  has  described  the  difference 


between  managers  and  leaders.2 
Managers  do  the  following: 

1 . Planning  and  budgeting. 

2.  Organizing  and  staffing. 

3.  Controlling  and  problem 

solving 

Leaders,  on  the  other  hand,  are 
responsible  for: 

1 . Establishing  direction. 

2.  Aligning  people. 

3.  Motivating  and  inspiring. 

It  is  in  these  latter  duties  that 
physicians  surely  can  and  must 
assume.  Many  of  the  largest  health 
care  systems  in  this  country  do  have 
physician  leaders;  for  example,  the 
Mayo  Clinic  and  Kaiser 
Permanente. 

Leadership  must  be  earned.  A 
medical  license  and  board  certifica- 
tion do  not  qualify  one  to  be  a 
leader.  Neither  does  a management 
degree.  One  way  is  to  work  within 
a large  organization  already  created 
by  others  and  to  assume  progres- 
sively higher  levels  of  responsibility 
in  the  management  hierarchy. 
Eventually,  you  may  emerge  a 
leader. 

The  other  way  is  to  create  an 
organization,  often  with  the  help  of 
others  — a single  specialty  group,  a 
multi-specialty  group,  an  indepen- 
dent practice  association,  an 
exclusive  provider  organization,  a 
physician/hospital  organization,  or 
some  as  yet  unnamed  entity  to 
provide  and  manage  health  care.  To 
create  an  organization  takes: 

• Investment  — raising  capital  to 
purchase  the  management 
systems  necessary  to  track 
resource  utilization  and  for  the 
initial  cash  flow.  (Continued) 


Colorado  Medicine  for  July,  1993 


213 


President's  Letter 

From  Physician  to  Provide  to  Vendor 

(Continued) 


by  Leigh  Truitt , MD 


• Risk  — tolerating  ambiguity 
and  the  prospect  of  financial 
loss  in  an  environment  of 
uncertainty. 

• Management  — developing 
the  business  systems  and 
personnel  necessary  to 
budget  and  control  a busi- 
ness enterprise. 

• Leadership  - creating  a 
coherent  vision  of  the  future, 
communicating  that  vision  to 
others,  and  motivating  those 
others  to  pursue  that  vision. 


I can  tell  you  from  personal 
experience  that  this  is  not  easy  and 
that  you  will  not  always  be  success- 
ful. Nevertheless,  if  we  are  not  to 
become  vendors  of  health  care 
services,  subjected  to  the  bulk 
purchase  of  health  care,  we  must 
raise  our  own  capital,  take  those 
risks,  manage  our  organizations  and 
be  leaders  in  the  changing  world. 
Otherwise,  we  will  be  managed  and 
led. 


References: 

1 "MD  offices  should  prepare  now  to  survive 
changes  brought  by  health  care  reform," 
Physician's  Marketing  & Management,  vol. 
6,  p.  1 , March,  1 993. 

2 John  P.  Kotter,  A Force  For  Change:  How 
Leadership  Differs  From  Management,  (New 
York:  The  Free  Press,  1990,  pp.  4-5.) 


THE  ARMY  RESERVE  OFFERS  UNIQUE  AND 
REWARDING  EXPERIENCES. 


As  a medical  officer  in  the  Army  Reserve  you  will  be  offered 
a variety  of  challenges  and  rewards.  You  will  also  have  a unique 
array  of  advantages  that  will  add  a new  dimension  to  your 
civilian  career,  such  as: 

• special  training  programs 

• advanced  casualty  care 

• advanced  trauma  life  support 

• flight  medicine 

• continuing  medical  education  programs  and  conferences 

• physician  networking 

• attractive  retirement  benefits 

• change  of  pace 

It  could  be  to  your  advantage  to  find  out  how  well  the  Army 
Reserve  will  treat  you  for  a small  amount  of  your  time.  An  Army 
Reserve  Medical  Counselor  can  tell  you  more,  call: 


1-800-432-7279 

ARMY  RESERVE  MEDICINE.  RE  ALL  YOU  CAN  BE.' 


214 


Colorado  Medicine  for  July,  1993 


A Unique 
Fringe  Benefit 
For  CMS  Members 


Buying  or  Leasing  a New  Car??? 


The  Colorado  Medical  Society  now  provides  a professional  fleet 
management  service  to  assist  members  throughout  the  state  when 
purchasing  or  leasing  a new  vehicle.  This  service  provides  valuable 
vehicle  information  such  as  factory  invoice  costs,  available  options, 
technical  data,  consumer  reports,  etc. 

Once  your  selection  is  firm,  your  purchase  or  lease  will  be  arranged 

at  prices  normally  available  only  to  large  corporate  fleets. 

Colorado  Medical  Society  has  endorsed  Rocky  Mountain  Fleet 
Associates  as  a CMS  member  service,  based  on  the  satisfaction  of 
the  many  physicians  who  have  used  their  services  over  the  past  several 
years.  These  physicians  have  reported  excellent  results,  usually 
with  savings  of  more  than  $1000  from  even  the  best  negotiated 
showroom  price. 

For  more  details,  call  (800)  864-4388.  In  Denver,  753-0440. 


Colorado  Medical  Society 


E 


XECUTI  VE 


Director's  Update 


"Darkness... 

and  Confusion " 


I was  on  a trip  to  Washington, 
DC.  in  May  this  year.  !t  was  during 
this  adventure  that  I learned  what  the 
letters  "DC"  really  stand  for  — 
"Darkness  and  Confusion".  This  is 
especially  true  when  it  comes  to  the 
political  climate  around  health  care 
reform.  What  will  happen  is  any 
one's  guess. 

I was  actually  in  Washington  to 
attend  an  AMA  State  Medical 
Advisory  Group  meeting.  This  group 
consists  of  1 1 states,  including 
Colorado.  We  meet  four  to  six  times 
a year  with  the  entire  staff  of  the 
AMA  Washington  Office  to  review 
federal  legislation  and  give  input 
regarding  priority  items.  Each  state  is 
also  asked  to  provide  an  update  on 
the  legislative  activities  within  their 
state. 

Obviously,  the  main  agenda 
item  for  this  meeting  was  health  care 
reform.  You  all  are  aware  of  the  fact 
that  the  AMA  is  not  considered  an 
"insider"  with  President  and  Mrs. 
Clinton  and  therefore,  the  AMA  is 
basing  their  information  on  discus- 
sions they  have  had  with  other 
outsiders. 

Here  are  some  of  the  highlights 
(or  lowlights,  depending  on  your 
point  of  view)  of  our  discussion: 

• The  AMA  feels  strongly  that 
the  top  considerations  of  Mrs. 
Clinton's  Task  Force  are 
freedom  of  choice  (the  ability 
of  citizens  to  choose  their 
own  physician)  and  quality  of 
care.  I was  surprised  and 
pleased  that  quality  had 
finally  made  its  way  into  the 
discussion. 


• There  is  a lot  of  support  for  a 
national  plan  however,  states 
wili  be  given  some  flexibility. 
The  Task  Force  will  establish 
specific  criteria  to  be  used  by 
the  individual  states.  To  no 
one's  surprise,  big  business 
does  not  support  state  flexibil- 
ity as  they  cross  state  lines 
and  therefore,  feel  that 
multiple  sets  of  criteria  would 
be  too  costly  and  confusing. 

• There  will  be  global  budget- 
ing. When  the  AMA  was 
asked  how  they  would  react 
to  50  different  global  budgets, 
they  replied  by  stating,  "the 
AMA  policy  is  silent  on  this 
question".  They  also  feel  that 
rigid  budgets  are  not  accept- 
able. So,  one  can  assume 
that  the  AMA  feels  that 
flexible  budgets  are  accept- 
able? Stay  tuned. 

• Fong  term  care  coverage 
probably  won't  happen  — too 
expensive. 

• "Managed  competition"  is  in 
trouble,  probably  due  to  the 
fact  that  freedom  of  choice  is 
a prime  consideration.  In 
fact,  rumor  has  it  that  the 
Jackson  Hole  Group  is  very 
upset.  Dr.  El Iwood  is  franti- 
cally lobbying  members  of 
the  Task  Force  to  keep 
managed  competition  alive. 

• There  is  strong  support  to  use 
mid-level  providers  as 
primary  care  givers,  espe- 
cially in  the  medically 


216 


Colorado  Medicine  for  July,  1993 


Sandra  L.  Maloney 
Executive  Director 
Colorado  Medical  Society 


underserved  areas  of  the 
nation.  The  AMA  is  leaning 
towards  supporting  this  effort, 
as  long  as  the  use  of  mid-level 
providers  coincides  with  each 
State's  scope  of  practice  laws. 

I wonder  how  the  AMA 
House  of  Delegates  will  react 
to  this  subject. 

• The  AMA  has  told  the  White 
House  that  physicians  must 
have  relief  from  anti-trust 
laws  and  related  regulations. 
Apparently  the  Democrats  are 
opposed  to  any  relief  for 
anyone  except  for  hospitals. 

• Any  tort  reform  will  likely  be 
limited  to  a requirement  for 
alternative  dispute  resolution 
(ADR). 

• No  detailed  information 
about  changes  to  the  ERISA 
laws.  There  are  two  bills 
currently  in  the  House  of 
Representatives  which  will 
give  an  exemption  to  only 
Minnesota  and  New  York.  In 
the  nation,  at  least  50%  of  the 
employers  are  self-insured. 

• The  Health  Insurance  Asso- 
ciation of  America  is  currently 
undertaking  a media  blitz  to 
promote  their  own  reform 
plan.  Rumor  has  it  that  health 
care  reform  will  eliminate  the 
need  for  insurance  agents. 
Most  of  you  will  not  think  that 
is  all  bad. 


Mrs.  Clinton  makes  a formal  an- 
nouncement. We  were  told  it  is 
likely  that  such  an  announcement 
may  not  come  until  mid-June. 
Interesting,  since  mid-June  was  when 
the  AMA  Annual  meeting  convened 
in  Chicago.  Hmm,  perhaps  the  AMA 
is  not  quite  the  insider  one  thought 
— how  convenient  to  have  about 
1 000  physicians  in  Chicago  at  the 
same  time  as  a formal  announce- 
ment is  made.  Could  have  been 
quite  an  event,  but  it  didn't  happen. 

Overall,  however,  I think  that  the 
AMA  Washington  staff  is  doing  its 
best  to  stay  on  top  of  health  care 
reform.  For  being  on  the  "outside", 
they  have  obtained  some  good 
information.  In  addition  to  health 
care  reform,  they  are  monitoring  an 
incredible  amount  of  other  federal 
legislation.  We  don't  hear  much 
about  the  lobbyists  and  other 
Washington  staff  but,  they  truly  have 
your  interests  at  heart  and  are  doing 
a good  job. 

In  future  issues,  I will  include 
information  on  pending  federal 
legislation.  Space  does  not  allow  me 
to  do  so  here.  If  you  have  immediate 
questions,  please  contact  me. 

As  this  is  going  to  print,  I will 
have  just  returned  from  Chicago  and 
the  AMA  Annual  Meeting  (another 
type  of  adventure).  Colorado's 
delegation  should  have  some 
comments  on  the  House  proceedings 
in  this  issue  of  Colorado  Medicine. 


" Any  tort  reform  will 
likely  be  limited  to  a 
requirement  for 

alternative  dispute 
resolution  ( ADR )." 


As  I stated  earlier,  this  is  all  pure 
speculation.  We  won't  know  until 


Colorado  Medicine  for  July,  1993 


217 


The 


Lobby 


by  Alan  Rapp.,  M.D.,  Chair 
Council  on  Legislation 
Sue  Ellen  Quam,  Director, 
CMS  Division  of  Government  Relations 
Lorraine  Koehn,  Lobbyist 


Legislative  sessions  are 
rarely  without  controversy 
on  how  best  to  respond  to 
health  care  responsibili- 
ties, cost,  utilization,  over- 
sight, scope  of  practice, 
patient  care,  their  rights 
and  freedom  of  choice 
issues.  This  year  was  par- 
ticularly challenging  with 
the  potpourri  of  legislative 
issues  needing  to  be  ad- 
dressed. 

Our  major  pieces  of  legislation  are 
listed  here,  including  private 
utilization  review;  employment  of 
physicians  by  rural  hospitals  ; 
statewide  employment  of  physicians 
by  any  individual  or  entity;  a bill 
opening  the  process  of  citizen 
complaints  with  the  BME  against 
physicians  while  seriously  limiting 
the  physician's  right  to  respond; 
development  of  a trauma  care  study; 
numerous  far  reaching  health  care 
reform  proposals;  and  the  ability  of 
lay  midwives  to  practice  legally  in 
our  state.  And  so,  here  they  are  in 
detail. 

NOTE:  A copy  of  the  complete  CMS 
Legislative  Status  of  the  Fifty-Ninth 
General  Assembly  is  available  on 
request  from  the  Government 
Relations  offices  at  CMS,  phone  779- 
5455  or  1-800-654-5653. 


CMS  strongly  supported  SB93- 
21,  CONCERNING  THE  RESPONSI- 
BILITY OF  HEALTH  CARE  COVER- 
AGE ENTITIES  FOR  THE  ACTIVITIES 
OF  PRIVATE  UTILIZATION  REVIEW 
ORGANIZATION  ACTING  ON 
BEHALF  OF  SUCH  HEALTH  CARE 
COVERAGE  ENTITIES.  Senator 
MaryAnne  Tebedo  and  Representa- 
tive Jim  Dyer  were  the  prime  spon- 
sors of  this  CMS  proposed  legisla- 
tion. 

SB93-086  CONCERNING  THE 
ESTABLISHMENT  OF  A STATEWIDE 
TRAUMA  SYSTEM  by  Senator  Dottie 
Wham  and  Representative  Lewis 
Entz  requires  the  Division  of  Emer- 
gency Medical  Services  within  the 
Department  of  Health  to  develop  a 
statewide  trauma  system  within 
existing  state  appropriations. 

HB93-1 151  CONCERNING 
MEASURES  TO  INCREASE  COOP- 
ERATION BETWEEN  THE  BOARD 
OF  MEDICAL  EXAMINERS  AND 
MEMBERS  OF  THE  PUBLIC  IN 
ADMINISTERING  THE  "COLO- 
RADO MEDICAL  PRACTICE  ACT". 
The  proposed  bill  would  have  given 
every  person  filing  a complaint 
against  a physician  with  the  board  of 
medical  examiners  the  right  to 
review  the  physician's  written 
answer  and  to  notify  the  board  of 
any  perceived  inaccuracies  in  the 
answer  with  no  right  for  the  physi- 
cian to  address  any  perceived 
inequities  in  the  patients'  response. 
CMS  opposed  this  legislation. 

HB93-1 244  CONCERNING  THE 
EMPLOYMENT  OF  HEALTH  CARE 
PROFESSIONALS  BY  LICENSED  OR 
CERTIFIED  HOSPITALS  LOCATED 
IN  COUNTIES  WITH  LOW  POPU- 
LATION, AND  IN  CONNECTION 


THEREWITH,  REQUIRING  THAT 
SUCH  HOSPITALS  NOT  LIMIT  OR 
CONTROL  PHYSICIANS'  INDEPEN- 
DENT PROFESSIONAL  JUDGMENT 
CONCERNING  THE  PRACTICE  OF 
MEDICINE  was  significantly 
amended  to  address  many  of  our 
concerns.  The  amended  bill  now 
clearly  states  that  it  is  the  physician's 
right  to  provide  care  to  the  patient 
without  interference  from  the 
hospital  regarding  use  of  services, 
facilities  and  equipment.  The  Senate 
HEWI  Committee  also  amended  the 
bill  to  say  that  the  bylaws  of  any 
hospital  which  employs  physicians 
shall  not  discriminate  on  the  basis  of 
whether  a physician  is  an  employee 
of,  or  a contracting  physician  with, 
the  hospital. 

HB93-1 322  CONCERNING 
HEALTH  CARE  REFORM,  which 
later  became  HB93-1  343,  by 
Representative  Mike  Coffman  and 
Senator  Blickensderfer  was  killed  in 
the  House  appropriations  committee. 
The  compromise  bill,  HB93-1  343, 
which  was  significantly  amended  to 
address  the  majority  of  our  concerns, 
was  defeated  in  the  Senate. 

HB93-1 051  CONCERNING  THE 
PRACTICE  OF  MIDWIFERY,  AND 
MAKING  AN  APPROPRIATION  IN 
CONNECTION  THEREWITH  was 
passed  by  the  General  Assembly 
with  substantial  amendments.  CMS 
worked  successfully  to  remove  the 
"grandmother"  provision  which 
would  have  allowed  anyone  who 
alleged  that  they  had  practiced  as  a 
lay  midwife  for  fifteen  years  to 
circumvent  these  requirements. 
Representatives  George,  Martin, 
Sullivan  and  Pankey  were  instrumen- 
tal in  this  effort. 


218 


Colorado  Medicine  for  July,  1993 


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coming  Clinton  health-care  reform 
proposals  are  not  yet  known,  there  is 
much  agreement  among  industry 
analysts  about  the  general  direction 
health-care  reform  is  taking,  and  how 
it  will  affect  the  way  medical  prac- 
tices do  business. 

Based  on  the  ongoing 
intelligence  we  are  acquiring, 
incuding  press  leaks  (thank  you.  Wall 
Street  Journal),  the  good  news  is  that 
reform  recommendations  which 
promise  to  affect  medical  office 
computer  systems  appear  to  make 
good  business  sense,  even  in  the 
absense  of  reform.  Some  examples: 

1.  Electronic  Billing.  The  direct 
transmission  of  paperless  claims 
is  faster,  more  accurate  and,  most 
significant  to  reformers,  cheaper. 
If  you  do  not  currently  submit 
claims  electronically,  you  should 
probably  do  so  now  in  order  to 
avoid  an  almost  certain  eleventh 
hour  rush  when  it  becomes 
mandatory. 

2.  Increased  User  Productivity. 

Since  reductions  in  the  amounts 
insurers  pay  providers  are  likely, 
even  in  the  short  term,  the 
emphasis  on  enhanced  collections 
(cash  flow)  and  judicious 
management  of  clerical  effort 
(salary  dollars)  is  crucial.  Not 
only  can  investment  in  a 
computer  system  that  fulfills 
these  requirements  be  plainly 
cost  justified  in  simple  business 
terms,  it  may  well  prove  to  be 
essential. 


3.  Managing  PPO  Contracts.  The 
proliferation  of  PPO's  and  other 
reduced  fee-for-service 
arrangements  will  continue,  so  it 
is  imperative  that  an  office 
system  manage  the  ever- 
increasing  variations  of  plans  and 
policies  - and  do  so  with  ease. 
Where  the  difference  in  effective 
management  of  these  contracts 
previously  meant  enhanced 
profitability,  it  could  now  very 
well  define  the  boundary  between 
the  financial  life  or  death  of  the 
practice. 

4.  Open  Industry  Standards. 

Interconnecuon  between  external 
office  equipment  (e.g.  fax 
machines  and  phone  systems), 
routine  communication  with 
outside  entities  such  as  hospitals, 
insurers  and  other  medical 
practices  are  becoming  both 
commonplace  and  necessary. 

The  appreciation  for  the  actual 
dollar  value  of  fast,  available, 
accurate  medical  information  is 
growing.  "Proprietary"  computer 
systems  that  lead  to  dependence 
of  a medical  practice  on  a single 
vendor  are  becoming  riskier  and 
riskier  investments  in  an  increas- 
ingly "open"  world. 

How  these  and  other 
computer  issues  affect  any  given 
practice  depends  on  the  unique 
requirements  of  each  office,  including 
considerations  of  existing  equipment 
and  software.  A strong,  financially 
viable  computer  vendor  with  expertise 
in  medical  practice  automation  and  a 


committment  to  providing  only 
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standard  solutions  is  the  best  insur- 
ance you  can  acquire  that  you  won't 
be  left  out  in  the  cold  as  health-care 
reform  suddenly  becomes  a reality. 


Mobile  Computing 
Reaches  Out  and 
Touches  Physicians 

Like  other  technological 
ideas  once  restricted  to  the  realm  of 
fantasy,  instant  untcthcred  computer 
communication  has  now  taken  on  the 
practical  reality  of  the  cellular  phone. 

Information,  including  voice 
and  images,  can  now  be  passed 
routinely  to  and  from  remote  loca- 
tions. A physician  in  the  field  can 
receive  electronic  mail  or  scheduling 
updates  from  his  office,  and  respond 
quickly  and  easily,  perhaps  even 
retrieve  a document  or  two,  with  or 
without  access  to  a phone  line. 

A scanned  image  of  a patient 
record,  EKG  or  lab  result  can  be 
retrieved  and  displayed  on-screen, 
right  in  the  physician's  home  or  car. 

In  fact,  it  is  becoming  clearer  every 
day  that  the  practical  applications  of 
mobile  computing  are  now  restricted 
more  by  our  own  limited  thinking 
than  by  technical  practicality. 

Mobile  computer  connection, 
limited  primarily  by  a simple  lack  of 
imagination,  is  no  longer  the  province 
of  the  science  fiction  water. 


Colorado  Medicine  for  July,  1993 


219 


The  Lobbby 

A physician  legislator's  view  of  1993 


by  Patrick  /.  Sullivan , M.D. 

Colorado  State  Representative 
District  50  (Weld  County) 


Access  to  medical  care  is  a 
concern  to  all  of  us  In  the  medical 
profession.  It  is  also  a concern  for 
the  population  at  large  as  repre- 
sented in  the  legislature.  What 
physicians  consider  access  is  not 
necessarily  congruent  with  the 
thoughts  of  individual  legislators. 

An  example  of  this  is  a recent 
law  which  legitimized  lay  midwives. 
Despite  the  best  efforts  of  your 
lobbyists  from  the  Colorado  Medical 
Society,  Sue  Ellen  Quam  and 
Loirraine  Koehn,  this  bill  finally 
passed  and  was  signed  by  the 
Governor. 

The  arguments  made  by  those 
favoring  the  bill  centered  around 
access  in  underserved  areas  like  the 
San  Luis  Valley  and  the  eastern 
plains  of  Colorado.  They  also 
stressed  choice,  lower  costs  and 
home  delivery.  Ultimately,  after 
several  years,  the  proponents  of  this 
bill  and  the  lay  midwives  won. 
Quality  of  care  as  an  issue  did  not 
prevail,  despite  repeated  testimony 
about  the  dangers  to  the  mother  and 
the  baby. 

A Good  Samaritan  amendment 
protects  physicians  who  have  to  take 
care  of  the  complications,  but 
attempts  to  mandate  malpractice 
insurance  for  the  lay  midwives 
failed.  A section  requiring  minimum 
training  for  the  midwives  was 
amended  on. 

There  are  similar  movements 
afoot  to  allow  more  freedom  to 
undertrained  psychologists,  etc.  and 
as  we  know  chiropractors  have  long 
been  fighting  for  and  winning  more 
medical  privileges. 

The  reason  these  groups  make 
inroads  is  not  because  of  the  purity 


of  their  intentions,  or  the  scientific 
basis  of  their  disciplines,  but  because 
they  understand  the  political  process 
and  exploit  it  to  the  fullest.  They 
have  recognized  the  need,  however 
unscientific,  and  dress  it  as  lower 
cost  access.  They  understand  the 
market  and  the  political  process 
where  all  too  often  we  as  physicians 
turn  up  our  noses  at  the  process. 

This  is  in  no  way  to  suggest  that 
physicians  should  not  fight  for  the 
principles  of  good  health  care.  I 
have  watched  with  pride  as  physi- 
cians have  testified  on  issues  that  go 
to  the  very  core  of  good  medical 
practice.  I have  been  particularly 
impressed  by  the  leaders  of  the 
Colorado  Medical  Society,  most 
recently  Dr.  Leigh  Truitt,  current 
president.  He  and  others  have 
worked  very  hard  to  educate  the 
legislature  on  health  matters. 

I have  also  cringed  on  occasion 
when  a physician  has  preached  at  a 
committee  hearing  and  has  other- 
wise shown  disdain  for  the  legislative 
process.  This  is  a sure  prescription 
for  losing  an  issue  in  the  short  term 
and  in  the  long  run  it  paints  a 
perception  of  arrogance  if  it  is  oft 
repeated. 

Passage  of  the  lay  midwife  bill 
should  teach  us  a lesson.  If  the 
medical  profession  is  going  to  be  a 
major  player  in  shaping  health  care 
reform  it  is  imperative  that  more 
physicians  become  familiar  with  and 
involved  in  the  political  process.  It  is 
difficult  when  there  is  a busy  prac- 
tice to  be  managed,  but  in  order  to 
influence  the  process,  more  doctors 
must  take  an  interest. 


"...  all  too  often  we  as 
physicians  turn  up  our 
noses  at  the  process 


220 


Colorado  Medicine  for  July,  1993 


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Colorado  Medicine  for  July,  1993 


221 


Health  Care  Reform 

Introduction  of  newly-created 
Health  Care  Reform  Committee 


by  Jo  Parkin , Program  Director 
Division  of  Health  Care  Financing 


Much  information  is  being 
collected  on 

ColoradoCare  and  health 
care  reform , as  well  as 
health  care  systems  in 
other  countries.  One  goal 
for  CMS  staff  is  to  compile 
a health  care  reform  hand- 
book to  assist  physicians 
in  understanding  and 
making  their  way  through 
health  care  reform.  If  you 
have  any  ideas  and  sug- 
gestions on  what  would 
be  helpful  to  you  in  such 
a handbook  or  if  you  are 
interested  in  obtaining 
information  on  health  care 
reform  topics  such  as 
these \ contact  Jo  Parkin  at 
(303)779-5455  or  1-800- 
654-5653. 


The  Colorado  Medical  Society 
(CMS)  Health  Care  Reform  Commit- 
tee has  been  created  to  assist  the 
Medical  Society  as  it  attempts  to 
decipher  the  array  of  health  care 
reform  initiatives  being  proposed. 

The  main  purpose  of  the  com- 
mittee is  to  study  health  care  reform 
initiatives  on  a state  and  national 
level  and  to  function  as  a resource  to 
the  CMS  Board  of  Directors,  House 
of  Delegates  and  general  member- 
ship providing  them  with  accurate, 
up  to  date  information  and  recom- 
mendations on  these  initiatives. 

The  Health  Care  Reform  Com- 
mittee has  recently  been  preparing 
for  the  ColoradoCare  public  hearings 
to  be  held  later  this  summer.  While 
the  Colorado  Medical  Society  has 
had  input  into  the  ColoradoCare 


process  thus  far,  the  public  hearings 
afford  us  yet  another  opportunity  to 
voice  our  opinions  and  concerns  and 
share  our  expertise. 

In  order  to  prepare  themselves, 
committee  members  have  split  into 
three  work  groups  and  have  been 
studying  ColoradoCare,  the  Clinton 
proposal,  and  health  care  reform 
initiatives  in  other  states.  They  are 
considering  how  these  proposals 
compare  to  the  CMS  policy  on 
health  care  reform.  After  educating 
themselves  on  these  topics,  the 
committee  will  be  recommending 
possible  modifications  to  the  existing 
policy. 

Media  reports  indicate  that 
introduction  of  the  Clinton  proposal 
has  been  delayed  until  Mid-July  at 
the  earliest  and  perhaps  as  late  as 


Colorado  Medical  Society 

Health  Care  Reform  Committee  of  the  whole 

Robert  M.  Bogin, 

M.D.,  Chair 

Thomas  J.  Allen,  M.D. 

Mark  Levine,  M.D. 

Wm.  Carl  Bailey,  M.D. 

Bonnie  McCafferty,  M.D. 

Richard  F.  Bakemeier,  M.D. 

Robert  D.  McCartney,  M.D. 

Mary  J.  Berg,  M.D. 

Louise  L.  McDonald,  M.D. 

Harrison  G.  Butler  III,  M.D. 

M.  Ray  Painter,  M.D. 

John  O.  Cletcher  Jr.,  M.D.,  Chair, 

Richert  E.  Quinn,  Jr.,  M.D. 

Colorado  Work  Group 

Alan  D.  Rapp,  M.D. 

Jonathan  C.  Feeney,  M.D. 

James  R.  Regan,  M.D. 

L.  Barton  Goldman,  M.D. 

Henry  J.  Roth,  M.D. 

Mary  Jo  Jacobs,  M.D.,  Chair, 

James  M.  Satt,  M.D. 

National  Work  Group 

John  A.  Sbarbaro,  M.D.,  MPH 

Mark  B.  Johnson,  M.D. 

Theresa  A.  Scholz,  MSI  1 1 

|oel  M.  Karlin,  M.D. 

W.  George  Shanks,  M.D. 

R.  Martin  Kiernan,  M.D. 

Nick  Slenkovich,  MSI 

Muryl  L.  Laman,  M.D. 

Terrance  J.  Sullivan,  M.D. 

Sherri  J.  Laubach,  M.D. 

Steven  J.  Thorson,  M.D. 

Jeremy  A.  Lazarus,  M.D.,  Chair, 

Leigh  Truitt,  M.D. 

Other  States  Work  Group 

Gary  VanderArk,  M.D. 

222 


Colorado  Medicine  for  July,  1993 


Health  Care  Reform  Committee 

(Continued) 


September,  so  the  details  of  the  plan 
are  not  yet  available.  However, 
Clinton  administration  officials  are 
indicating  that  we  can  expect  to  see 
the  following  components  of  health 
care  reform  addressed  in  the  pro- 
posal at  the  national  level: 

• Standard  benefit  package 

• Payment  mechanism 

• Insurance  and  marketplace 
reform  including  mandatory 
community  rating  and  changes  in 
underwriting  practices 

• Freedom  of  choice  for  consumers 
to  choose  their  own  health  plan 
and  physician 

• National  standards  set  for  quality 

• Plans  to  strengthen  the  supply  of 
primary  care  providers 

• State  alliances  offering  either  a 
single  or  multi-payer  system  (see 
AMA  Update  in  this  issue  for 
more  details). 

It  has  been  said  that  basic 
ground  rules  will  be  set  at  the 
national  level  and  individual  states 
will  have  flexibility  to  implement 
programs  tailored  to  the  needs  of 
their  residents. 

With  this  in  mind,  the  impor- 
tance of  participating  in  the 
ColoradoCare  process  is  reaffirmed. 

The  ColoradoCare  project 
publishes  a newsletter  detailing  the 
progress  of  the  feasibility  study 
currently  being  conducted.  The 
feasibility  study  includes  six  commit- 
tees studying  the  intricacies  of  the 
following  components  of  the 
ColoradoCare  proposal:  1)  benefits, 

2)  access,  3)  quality  of  care,  4) 
program  finance  and  economic 
effects,  5)  actuarial  and  , 6)  cost 
containment.  The  newsletter  details 
the  committees  work.  All  committee 
meetings  are  open  to  the  public  and 
a meeting  schedule  is  also  included 
in  the  newsletter.  To  get  on  the 
mailing  list  for  the  newsletter  call  the 
Health  Care  Reform  Initiative  at  866- 
2155. 


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223 


AMA  Update 

Health  Care  Reform 

First  Lady  and  the  AMA 

Address  to  the  Annual  Meeting  of  the  AMA  House  of  Delegates,  June  1 3,  1 993. 


First  Lady  Hillary  Rodham  Clinton 
speaking  to  the  AMA  House  of 
Delegates 


"Choice  ...  also  means 
that  physicians  will  have 
the  ability  to  choose  the 
plan  in  which  they  will 
participate 

Robert  D.  McCartney,  M.D. 


The  Colorado  Delegation  to  the 
American  Medical  Association  was 
fortunate  to  be  present  when  Mrs. 
Clinton  addressed  the  House  of 
Delegates  during  the  opening  of  the 
142nd  Annual  Meeting.  Amid  the 
great  anticipation  of  the  delegates, 
she  relayed  reassurances  regarding 
elements  of  the  soon-to-be  an- 
nounced Clinton  health  plan.  The 
elements  she  discussed  included: 

1.  Universal  Access:  All  Ameri- 
cans deserve  a health  care  system 
that  they  can  access,  regardless  of 
where  they  live,  where  they  work 
and  what  preexisting  illnesses  they 
have  experienced. 

2.  Cost  containment:  The  new 
system  must  reduce  the  costs  of 
health  care,  both  in  terms  of  dollar 
expenditure,  and  in  terms  of  the 
human  factor.  This  latter  factor 
includes  the  hassles,  paperwork,  and 
reporting  redundancy  that  exists  in 
the  current  system.  It  also  includes 
the  reimbursement  omissions  that 
have  undermined  the  effectiveness  of 
medical  treatment  plans.  The  most 
obvious  of  these  is  the  failure  of  most 
current  health  plans  to  pay  for 
prescription  drugs.  Patients  who  fail 
for  financial  reasons  to  fill  their 
prescriptions  upon  discharge  from 
the  hospital  often  reenter  the  system 
generating  even  greater  health 
expenditures. 

3.  An  American  System:  While 
all  of  the  other  major  health  care 
systems  of  the  world  have  been 
reviewed,  the  Clinton  team  has 
concluded  that  an  American  solution 
is  needed.  The  two  key  components 
of  this  solution  are 

(a)  Quality 

(b)  Choice 


Quality  has  many  faces.  Most 
important  is  the  necessity  of  the 
American  public  to  have  a health 
care  system  that  they  believe  in  and 
trust.  Quality  also  means  more 
primary  care  physicians.  It  means 
continued  funding  for  graduate 
medical  education.  It  means  greater 
reimbursement  for  the  services  that 
primary  care  physicians  provide.  It 
means  funding  and  opportunity  for 
mid-career  education  for  physicians 
who  wish  to  change  their  specialty  to 
primary  care. 

Choice  means  that  patients  will 
be  able  to  choose  their  physician.  It 
also  means  that  physicians  will  have 
the  ability  to  choose  the  plan  in 
which  they  will  participate.  It  means 
that  physicians  will  be  able  to 
participate  in  more  than  one  pian. 

4.  Underwriting  reform:  The 
Clinton  system  will  propose  commu- 
nity rating,  removal  of  all  penalties 
for  preexisting  illness,  and  will  offer 
a federally  mandated  benefit  pack- 
age that  emphasizes  primary  care 
and  prevention. 

5.  Outcome  research  and 
practice  parameters:  In  order  to 
better  guide  practitioners  in  their 
medical  practices,  practice  param- 
eters will  be  made  available  in  a 
meaningful  and  usable  form.  Con- 
tinued funding  will  be  available  for 
medical  research  to  allow  us  to  learn 
the  consequences  of  our  medical 
interventions. 

6.  Managed  Care:  Managed 
care  techniques  will  be  employed  in 
the  Clinton  proposal,  but  it  shall  be 
the  employee,  not  the  employer, 
who  chooses  the  plan  for  participa- 
tion. By  allowing  employees  to 
select  the  plan,  there  will  be  greater 


224 


Colorado  Medicine  for  July,  1993 


Ten  areas  likely  to  be  included  inthe  Clinton  Health  Care  Plan 


emphasis  on  preserving  established 
doctor-patient  relationships. 

7.  Utilization  review:  Current 
utilization  review  practices  are 
regressive,  encouraging  physicians  to 
perform  more  testing  to  document 
the  rationale  for  their  treatment 
plans.  Physicians  who  use  restraint 
in  their  testing  are  actually  punished 
under  the  current  system.  The 
Clinton  plan  will  encourage  more 
true  peer  review,  scrutiny  of  other's 
practice  patterns,  and  reporting  of 
actions  observed  (examples  of 
substandard  care). 

Micromanagement  by  nonphysicians 
will  be  largely  eliminated.  Physi- 
cians will  be  encouraged  to  police 
themselves,  and  the  legal  barriers  to 
doing  so  will  be  eliminated. 

8.  Clinical  Laboratory  Improve- 
ment Amendments:  The  burden- 
some regulations  imposed  by  CLIA 
will  be  reviewed,  retaining  the  true 
essence  of  the  amendments,  and 
eliminating  that  which  is  hassle. 

9.  Prevention:  Not  only  will 
prevention  be  a part  of  the  federally 
mandated  benefit  package,  but 
doctors  in  training  will  be  instructed 
in  delivery  of  preventive  care. 
Additionally,  medical  education  will 
include  common  sense  wellness, 
such  as  exercise  and  nutrition. 

10.  Malpractice:  Curbs  will  be 
implemented  to  stop  the  current 
malpractice  crisis.  The  solution  must 
be  one  that  engenders  the  confi- 
dence of  the  public.  It  also  will  be  a 
solution  that  will  encourage  the 
profession  to  take  action  against  the 
same  doctors  who  have  been  the 
targets  of  repetitive  lawsuits.  The 
profession  can  and  will  identify  and 


by  Robert  D.  McCartney , M.D.,  F.A.C.P. 

Alternate  Delegate 
Colorado  Medical  Society 


weed  out  these  providers.  Malprac- 
tice litigation  will  be  tempered  by 
self-policing. 

Mrs.  Clinton's  remarks  sparked 
repeated  peals  of  applause  from  the 
capacity  crowd  in  the  International 
Ballroom  of  the  Chicago  Hilton 
Towers.  The  positive  and  upbeat 
address  gave  a glimpse  of  optimism 
to  the  House  of  Medicine,  which  has 
been  laboring  over  potential  details 
of  a reform  package. 

Still,  there  are  many  unknowns. 
What  is  the  change  in  quality 
assessment,  malpractice  reform  and 
micromanagement  that  will  allow  for 
both  public  confidence  and  the 
ability  for  medicine  to  police  itself? 

Is  it  enterprise  liability?  And  what  is 
the  blend  of  managed  care  that 
allows  both  patients  and  physicians 
choice?  Is  it  a point  of  service 
model?  And  how  will  the  number  of 
primary  care  physicians  be  ex- 
panded? Will  this  involve  the  use  of 
allied  health  professionals  acting 
along  side  with  or  in  competition 
with  physicians?  These  specifics 
were  not  addressed  by  the  First  Lady. 
We,  too,  must  wait  until  that  elusive 
date  when  the  Clinton  Health  Plan  is 
finally  announced. 


"The  positive  and  upbeat 
address  gave  a glimpse  of 
optimism  to  the  House  of 
Medicine. . . " 


Colorado  Medicine  tor  July,  1993 


225 


ROM  THE  AMA 

Report  to  the  Federation 


by  James  S.  Todd,  M.D.,  Executive  Vice  President 
American  Medical  Association. 


(Chicago,  IL  - April  26,  1 993)  As 
the  national  debate  over  health 
system  reform  enters  its  next  critical 
stage,  the  AMA  is  engaged  in 
medicine's  most  intensive  lobbying 
effort  in  a generation.  The  game  plan 
is  being  executed  on  two  fronts:  In 
Washington,  of  course,  on  both  ends 
of  Pennsylvania  Avenue,  and  across 
the  breadth  of  the  entire  Federation. 

There  is  no  question  about  it. 

We  are  right  in  the  thick  of  a politi- 
cal campaign.  The  decisions  that 
will  be  made  in  Washington  in  the 
weeks  and  months  ahead  will  affect 
physicians  and  patients  far  into  the 
next  century. 

Fortunately,  no  one  outside  of 
government  has  had  more  access  to 
the  top  levels  of  the  Clinton  Adminis- 
tration when  it  comes  to  health 
system  reform  than  has  the  AMA. 

We  have  made  our  case  to  Mrs. 
Clinton's  full  Health  Care  Task 
Force.  AMA  Board  members  have 
met  with  Task  Force  working  groups 
on  issues  of  quality,  professional 
liability,  negotiations,  anti-trust  relief, 
cost  containment  and  physician  and 
patient  choice. 

Most  importantly,  AMA  officers 
have  met  several  times,  for  hours  at  a 
stretch,  with  Ira  Magaziner,  the  man 
in  charge  of  the  President's  health 
system  reform  operation. 

Our  message  has  been  direct: 

We  support  reform  that  puts  our 
patients  first  without  jeopardizing 
our  profession's  legitimate  best 
interests. 

This  is  some  of  what  we  have 
told  the  President  and  Mrs.  Clinton: 

1 .  No  system  is  going  to  work  unless 
it  gives  patients  the  freedom  to 
choose  their  own  physicians,  and 


physicians  the  freedom  to  chose  how 
they  practice,  including  fee-for- 
service. 

2.  Strict  global  budgets  and  govern- 
ment price  controls  are  unwise, 
unworkable  and  will  do  more  harm 
than  good. 

3.  Physicians  must  have  the  ability 
to  negotiate  without  antitrust 
sanctions. 

4.  Reform  will  succeed  only  if 
practicing  physicians  are  involved 
— and  not  just  the  well-intentioned, 
but  naive  ivory  tower  academics 
who  are  helping  Mrs.  Clinton. 

5.  Organized  medicine  will  stay 
involved  every  step  of  the  way, 
straight  through  putting  reform  into 
action  once  Congress  does  its  part. 

Both  the  Administration  and 
Congress  have  heard  medicine's 
message,  thanks  in  large  part  to  the 
remarkable  "Days  of  Partnership"  in 
March  when  some  1 ,000  AMA- 
member  physicians  from  all  over 
America  converged  on  Washington 

I have  not  seen  anything  like  it  in 
all  my  years  with  the  AMA.  The 
country's  top  elected  leaders  actually 
came  to  medicine's  mountain  for  a 
change. 

From  Congress  came  Mitchell, 
Dole,  Gramm,  Gingrich,  Rockefeller, 
Nickles,  Stark  and  Kennedy. 

From  the  Administration  came 
Secretary  Shalala  and  Vice  President 
Gore,  who  told  us,  "We  want  to 
write  a plan  that  allows  you  to  return 
full  time  to  medicine."  We  will  hold 
them  to  their  word. 

We  expect  both  good  and  bad 
news.  Universal  access,  a compre- 
hensive benefit  package,  freedom  of 
choice,  liability  reform,  regulatory 
and  antitrust  relief  may  all  be  part  of 


the  President's  plan. 

But  we  also  expect  the  Adminis- 
tration to  seek  some  kind  of  conces- 
sion over  fees  and  expenditures.  The 
AMA  is  as  strongly  opposed  as  ever 
to  government  controls,  and  this,  we 
have  told  Mr.  Magaziner,  is  where 
we  draw  the  line  in  the  sand. 

In  the  meantime,  the  President's 
timetable  keeps  slipping,  with  a plan 
for  reform  not  due  out  until  well  into 
his  administration's  second  hundred 
days. 

When  he  does  act,  AMA  na- 
tional and  regional  teams  of  physi- 
cians will  immediately  respond 
through  the  media.  An  indepth  AMA 
analysis  will  be  mailed  to  every 
physician  in  the  country  within  a 
week.  A grass  roots  campaign  will 
target  patients.  And  in  Washington, 
of  course,  we  will  mount  the  most 
vigorous  Congressional  effort  in  our 
history,  fighting  for  what  is  best  for 
patients  and  physicians  alike. 

These  are  trying  times  for 
everyone  in  medicine.  It  is  easy  to 
feel  frustrated,  angry,  even  afraid,  for 
our  world  is  about  to  change. 

But  remember,  this  game  won't 
be  played  out  until  it  gets  to  Capitol 
Hill,  where  it  will  take  months  of 
committee  hearings  before  any 
legislation  emerges. 

If  our  recommendations  are 
accepted  we  will  be  very  pleased. 

But  if  the  President  fails  to  do  the 
right  thing,  then  we  will  consider  our 
role  as  the  loyal  opposition. 

And  remember:  Patient  care  is 
the  bottom  line  that  has  always 
defined  medicine's  special  interest, 
and,  with  your  help,  it  always  will. 


226 


Colorado  Medicine  for  July,  1993 


Recent  amendments  to 
the  Code  of  Colorado 
Regulations  that  may  be 
of  particular  interest 

At  its  March  16,  1993  meeting, 
the  Board  of  Health  made  the 
following  amendments: 

to  the  Rules  and  Regulations 
Pertaining  to  the  Reporting, 
Prevention,  and  Control  of  AIDS, 
HIV  Related  Illness,  and  HIV 
Infection 

1.  Add  to  the  list  of  what  laborato- 
ries shall  report  to  the  Colorado 
Department  of  Health  1 ) 
positive  latex  agglutination  tests 
for  HIV  and,  2)  CD4  counts  < 
500  mm^  or  CD4%  < 29% 
regardless  of  HIV  test  results. 

When  associated  with  other 
clinical  or  laboratory  evidence 
of  HIV  infection,  the  Board  of 
Health  defines  a CD4  test  result 
in  the  range  listed  above  as  the 
primary  immunologic  measure 


indicating  severe  HIV  infection 
and  when  less  than  200  mm^ 
as  defining  AIDS.  The  Health 
Department  will  destroy 
personal  identifying  informa- 
tion on  all  persons  with  CD4 
results  in  the  reportable  range  if 
investigation  subsequent  to  the 
report  finds  no  evidence  of 
infection. 

to  the  Rules  and  Regulation 
Pertaining  to  The  Infant  Immuniza- 
tion Program 

1 . The  fee  that  private  practitio- 
ners may  charge  the  Medicaid 
program  for  administering, 
reporting,  and  tracking  an 
immunization  required  by  rule 
VI  to  a Medicaid-enrolled 
infant  shall  be  a maximum  of 
six  dollars  and  fifty  cents  per 
vaccine. 

2.  A vaccine  recipient  may  not  be 
denied  vaccine  provided  by 
the  Centers  for  Disease  Control 
and  Prevention  federal  grant 
because  of  the  inability  to  pay 
the  administrative  fee. 


Dr.  Kelly  leaving  the 
Sports  Medicine 
team 

James  P.  Kelly,  M.D.,  Chair  of 
the  CMS  Sports  Medicine  Committee 
since  1992,  has  accepted  the 
position  of  Director  of  Brain  Injury 
Rehabilitation  Programs  at  the 
Rehabilitation  Institute  of  Chicago. 
Dr.  Kelly's  duties  as  Director  will 
begin  on  July  1,  1993.  Additionally, 
Dr.  Kelly  will  serve  as  Assistant 
Professor  of  Rehab  Medicine  and 
Neurology  at  Northwestern  Univer- 
sity Medical  School.  Dr.  Kelly  was 
one  of  the  principles  in  the  develop- 
ment of  the  CMS  Sports  Medicine 
Committee  Head  Injury  Guidelines. 
These  guidelines  have  been  widely 
accepted  and  adapted  across  the 
U.S. 

Thank  you  Dr.  Kelly  for  your 
leadership.  Best  wishes  in  your  new 
position. 


1993  CMS  Annual  Meeting 
House  of  Delegates 
Snowmass  Village,  Colorado^ 
September  9-12 
For  the  whole  family! 


Colorado  Physician 
Health  Program 

Dedicated 

to 

Physician  Peer 
Assistance 


899  Logan  Street 
Suite  505 
Denver,  CO  80203 
303-860-0122 
1-800-927-0122 


Please  take  note  of  the  address  change 
for  The  Colorado  Physician  Health 
Program. 

CPHP  is  now  located  at 
899  Logan  Street 
Suite  506 
Denver  80203 

Our  new  offices  are  f idly  accessible  to 
physicians  with  mobility  impair- 
ments. 


CPHP  serves  the  needs  of  the  Colo- 
rado medical  community  through 
problem  identification,  treatment  re- 
ferral, monitoring,  clinical  consulta- 
tion and  support  to  individuals  and 
their  families. 

Physicians  who  may  be  experienc- 
ing physical,  emotional,  or  psycho- 
logical problems  may  elect  to  refer 
themselves  for  evaluation.  Family 
members,  colleagues,  or  other  con- 
cerned individuals  may  also  provide 
a referral  for  a physician  in  need  of 
assistance. 


Colorado  Medicine  for  July,  1993 


227 


Health  Care  Reform 


AMA's  "New  Partnership" 
comfort  level  questionable 

John  C.  Seiner ; M.D.,  President 
American  College  of  Allergy  & Immunology 


Tribal,  regional,  religious  and  cultural  influences  in  political  decision-making. 


"I,  for  one , am  not  reassured 
by  J.  Rockefeller's  plea  to 

trust  the  politicians 


Editor: 

John  C.  Seiner ; M.D.,  of  Denver 
and  President  of  the  American  Col- 
lege of  Allergy  & Immunology,  at- 
tended the  AMA-sponsored  meet- 
ing in  Washington  between  mem- 
bers of  Congress,  the  AM  A and  the 
Clinton  Administration  March  23- 
25.  The  AMA  titled  it  "A  Time  for 
New  Partnership." 

Dr.  Seiner's  observations  reprinted 
here  are  his  own  and  do  not  repre- 
sent the  views  of  the  American  Acad- 
emy of  Allergy  & Immunology  or 
the  Colorado  Medical  Society. 


Fred  Lewis  (Fredrick  A.  Lewis, 

Jr.,  M.D.,  Denver)  reported  on  these 
pages  in  May  (COLORADO  MEDI- 
CINE, Vol.  90,  No.  5,  May,  1 993,  pp 
174-175)  his  impressions  of  the 
Mayflower  Hotel  happening  between 
the  AMA,  members  of  Congress  and 
the  Clinton  Administration.  I feel  his 
succinct  comments  as  to  what  these 
folks  had  to  say  are  accurate. 
However,  he  failed  to  include 
Senator  Phil  Graham  (R-TX).  I found 
Senator  Graham's  comments,  to  say 
the  least,  provocative  and  worthy  of 
some  thought  by  AMA  leaders. 

I would  add  that  I personally  was 
reminded  of  Thomas  L.  Friedman's 
book,  (From  Beirut  to  Jerusalem, 
Farrar,  Straus  & Giroux,  New  York; 
1989).  Friedman  focuses  on  the 
Middle  East  conflict  and  the  critical 
importance  of  understanding  tribal, 
regional,  religious  and  cultural 
influences  in  political  decision- 
making. The  decision  to  dispatch 
Marines  to  Beirut  didn't  factor  in  the 
quicksand  of  Middle  East  politics. 

The  Marines  went  in  thinking  they 
could  resolve  conflict  or  at  least 
separate  the  combatants  in  that 
"crisis".  We  all  recall  what  hap- 
pened. I,  for  one,  am  concerned  as 
to  whether  AMA  leadership  or  any  of 
us  recognized  the  quicksand  of  the 
beltway  culture,  legalcrats  who  covet 
control  over  the  most  conspicuous  of 
America's  success  stories  - medicine. 

When  Bob  Dole  displayed  a 
picture  of  the  White  House  with  the 
comment,  "I  want  you  to  know  what 
it  looks  like  in  case  you  do  not  get  a 
chance  to  see  it  in  person,"  he 
seemed  to  warn  MD's  just  how 
extraordinary  a move  it  was  for  the 
Administration  to  be  excluding  from 


its  "crisis"  solving  team  those  who 
actively  take  care  of  patients.  Was 
anybody  listening?  Do  we  really 
think  that  the  lawyers,  insurance 
executives  and  politicians  have  the 
answers  to  this  "crisis"  ? 

Another  comment,  regrettably,  is 
to  acknowledge  an  uneasiness  when 
AMA  President,  John  L.  Clowe,  MD, 
suggested  an  AMA  endorsement  of 
the  concept  of  managed  competi- 
tion. I personally  do  not  feel  that  I 
understand  managed  competition  as 
it  will  be  executed  by  this  adminis- 
tration. Frankly,  at  the  time  of  Dr. 
Clowe's  utterance,  I was  fairly 
certain  that  nobody  in  the  assembled 
audience,  in  the  leadership  of  AMA 
and  perhaps  even  in  the  administra- 
tion, could  define  managed  competi- 
tion. I,  therefore,  felt  it  was  a bit 
premature  to  be  endorsing  this 
strategy. 

My  uneasiness  grew  to  frank 
alarm  when  AMA  statements  seemed 
to  be  suggesting  that  they  agreed 
with  the  need  for  an  overhaul  of  the 
entire  system  of  medical  care.  This 
came  on  the  heels  of  declarations 
that  the  American  medical  system 
gave  better  medical  care  to  more 
citizens  than  any  other  system  in  the 
world.  AMA'S  reference  to  a "crisis" 
and  a need  for  change  seems  to  be 
addressing  antitrust  laws  that  frus- 
trate, liability  constraints  that  intimi- 
date, access  barriers  that  dehuman- 
ize and  insurance  schemes  that  make 
big  business  out  of  a fundamental 
need  for  healthcare.  Is  this  what  the 
politicians  are  talking  about  or  are 
they  structuring  the  single  largest 
stifling  bureaucracy  that  this  country 
has  ever  imagined?  Maybe  it  is  the 
country  boy  in  me  who  thinks  that  if 


"New  Partnership" 

(Continued) 


an  automobile  has  a broken  radiator, 
needs  a new  transmission  and 
windshield  wipers,  you  go  out  and 
replace  them  rather  than  reinvent  the 
automobile.  Nobody  would  argue 
that  the  U.S.  healthcare  system  is  in 
need  of  reform  but  I,  for  one,  am  not 
reassured  by  Jay  Rockefeller's  plea  to 
trust  the  politicians  to  do  what  is 
right  for  the  American  public.  These 
realities  and  other  perceptions  leave 
me  less  than  reassured  by  the 
posturings  of  AMA  leadership  during 
this  meeting. 

Healthcare  reform  has  been 
positioned  as  perhaps  the  most 
important  socio-economic  issue  of 
our  time.  The  "crisis"  in  medical  care 
delivery  has  many  origins.  Failure  to 
acknowledge  and  correct  the 
physician  component  of  the  "crisis" 
would  be  a grave  misstep.  A greater 
mistake,  in  my  view,  would  be  to 
surrender  the  future  of  medicine  to 
the  wild  imaginations  of  a political 
culture  composed  largely  of  social 
engineers  whose  policies  have  failed 
miserably  in  the  past.  Physicians  did 
not  invent  the  present  healthcare 
mess.  They  went  along  with  it.  Now, 
the  profession  is  paying  the  price. 

Perhaps  medicine  should 
consider  very  carefully  the  comment 
of  Newt  Gingrich  made  to  standing 
applause.  He  was  asked,  following 
his  presentation,  if  he  was  consider- 
ing a run  for  the  Presidency  in  1 996. 

I can  only  paraphrase  him  but  he 
stated,  "It's  very  important  for  you  all 
to  understand  what  is  going  on  here. 
This  is  not  about  who  is  to  be 
President.  This  is  about  retaining  the 
basic  culture  of  this  country." 
Gingrich  seemed  to  be  asking  the 
essential  questions.  Does  the  medi- 
cal profession  recognize  that  at  risk 
here  is  one  of  our  society's  singular 
boasts,  modern  medicine?  And 
perhaps  as  important,  who  and  what 
determines  the  soul  of  medicine  in 
1993? 


Credentialing  and  Peer 
Review  Project  On  Hold 

At  the  1 992  Annual  Meeting  the 
CMS  House  of  Delegates  passed  Res- 
68-P  as  follows: 

RESOLVED,  that  the  Colorado 
Medical  Society  establish  a mecha- 
nism for  providing  assistance  in 
credentialing,  privilege  determina- 
tion and  peer  review  when  circum- 
stances inhibit  a hospital  or  commu- 
nity from  providing  such  services, 
and  be  it  further 

RESOLVED,  that  such  a mecha- 
nism include  protocols  for  the 
appropriate  provision  of  these 
services  and  a list  of  physicians  who 
are  available  to  participate  in  such 
services. 

In  April,  a survey  was  sent  to  all 
hospital  medical  staff  offices  and 
chiefs  of  staff  in  an  effort  to  deter- 
mine what  services  were  needed  and 
the  extent  to  which  they  would  be 
utilized.  To  date,  we  have  received 
6 responses  ( Gunnison  Valley, 
Cheyenne  County,  Family  Health 
West,  Vail  Valley,  and  Kit  Carson 
County  Memorial)  only  3 of  which 
expressed  a strong  need  for  these 
services  as  well  as  an  indication  that 


Dr.  H.  G.  Butler,  III,  corporate  practice; 
Dr.  Dennis  Chalus,  corporate  practice; 
Dr.  Renee  Cousins,  Repr.  Armstrong's 
BME  bill; 

Dr.  James  Delaney,  lay  midwifery; 

Dr.  Willy  Devilla,  Norplant; 

Dr.  John  Eliff,  corporate  practice; 

Dr.  Carole  Jenny,  "Religious  Practice"  as 
a defense  in  child  abuse  cases; 

Dr.  Mary  Jo  Jacobs,  lay  midwifery  and 
smoking; 

Dr.  Mark  lohnson,  smoking; 


they  would  use  them  if  available.  In 
addition,  the  Colorado  Hospital 
Association  has  recently  imple- 
mented a centralized  credentialing 
service  for  Colorado  hospitals  so  at 
least  a part  of  the  need  has  been 
addressed. 

These  responses  would  seem  to 
indicate  that,  while  the  concept  was 
a good  one,  the  development  of  this 
project  may  not  be  necessary, 
especially  in  light  of  the  growing 
number  of  networks  between  smaller 
rural  hospitals  and  larger  ones.  Per 
discussions  with  legal  counsel,  such 
a project  is  not  as  simple  as  develop- 
ing a pool  of  physicians  willing  to 
participate  in  these  services  on  an  as 
needed  basis.  Therefore,  it  has 
been  suggested  that  we  should  not 
proceed  with  this  project  unless  we 
receive  additional  input  from  our 
membership  indicating  that  it  would 
be  utilized  by  your  hospitals. 

If  you  feel  strongly  that  there  is  a 
need  for  this  service  in  your  area, 
please  ask  your  hospital  to  return  the 
survey  indicating  their  estimated 
need  for  such  assistance. 


Dr.  Steve  Lowenstein,  motorcycle 
helmets;  Robert  McCartney,  private 
utilization  review  organizations; 

Dr.  Leslie  Stanwix,  lay  midwifery; 

Dr.  Leigh  Truitt  for  his  excellent 
testimony  on  numerous  occasions; 

Dr.  Janice  Ugale,  Repr.  Armstrong's 
BME  bill, 

Dr.  Ted  Youngberg  on  corporate 
practicee  and  trauma  legislation. 

Thanks  also  to 

Dave  Burledge,  CMS  legal  counsel,  and 

George  Dikeou,  Copic  Insurance 
Company  general  counsel. 


Thank  you  to  '93  legislative  testifiers 

Kudos  to  the  physicians  who  took  time  from  their  busy  practices  to  testify 
on  behalf  of  medical  professionals  about  issues  of  importance  to  medicine. 
We  urge  you  to  personally  thank  the  following  testifiers: 


Colorado  Medicine  for  July,  1993 


229 


Heal 


th  Care  Reform 


Huge  national  medical  coalition  opposes 
"Enterprise  Liability"  concept 


June  5,  1993 


On  Saturday ’ June  5,  the 
AM  A delivered  to  Ira 
Magazines  manager  of 
President  Clinton's  health 
system  reform  task  force , a 
letter  signed  by  virtually 
every  AMA-  member 
organization , expressing 
opposition  to  " enterprise 
liability"  as  a vehicle  for 
tort  reform.  The  Colorado 
and  Wyoming  Medical 
Societies  were  among  the 
first  of  the  nearly  150 
health  care  signatories. 

The  text  of  the  letter  is 
reproduced  here. 


Ms.  Hillary  Rodham  Clinton,  Chair 

White  House  Task  Force  on  Health  System  Reform 

The  White  House 

Washington,  DC  20500 

Dear  Ms.  Clinton: 

The  Clinton  Administration's  plan  for  comprehensive 
health  care  reform  must  include  significant  medical 
liability  reform  designed  to  reduce  liability  costs  and 
improve  patient  safety.  Nationwide  application  of  the 
tort  reforms  enacted  in  California  in  1975,  known  as 
the  Medical  Injury  Compensation  Recovery  Act  (MICRA) , 
is  the  best  proven  reform  model  available.  In  imple- 
menting the  MICRA  reforms,  the  federal  government 
should  apply  them  to  all  personal  injury  claims  arising 
in  the  course  of  health  care  and  encompass  all  poten- 
tial defendants,  including  physicians,  nurses  and  other 
practitioners,  hospitals,  managed  care  organizations 
and  the  producers  of  medicines  and  medical  devices. 

The  concept  known  as  "enterprise  liability"  is  un- 
proven and  will  not  correct  fundamental  deficiencies  in 
the  tort  system.  It  will  probably  increase  costs  over- 
all. A White  House  Task  Force  recommendation  for  na- 
tionwide enterprise  liability  in  the  medical  sector 
would  not  be  an  acceptable  alternative  to  the  MICRA 
reforms . 

The  undersigned  organizations  also  support  efforts 
to  strengthen  state  licensing  boards,  and  encourage 
patient  safety  research  and  risk  management  education 
in  all  health  care  delivery  settings. 

The  medical  profession  and  other  providers  of  health 
care  have  struggled  with  liability  reform  for  over 
twenty  years.  Patients  support  us  in  seeking  to  place 
reasonable  limits  on  a costly  and  inefficient  system 
that  discourages  value-conscious  behavior. 

Investigation  of  alternative  dispute  resolution,  pre- 
trial screening  mechanisms  and  legal  uses  of  practice 
parameters  may  all  be  warranted. 

However,  no  health  reform  package  will  be  satisfac- 
tory to  the  undersigned  organizations  if  the  MICRA 
reforms  are  not  included. 

Sincerely, 


230 


Colorado  Medicine  for  July,  1993 


Tentative  Annual  Meeting  Registration 

1 993  Annual  Meeting  of  the  Colorado  Medical  Society,  September  9-1 2,  1 993,  Snowmass  Conference  Center 

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Please  check  all  that  apply 


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Reservation  deadline  is  August  27,  1993.  Reservations  accepted  on  a first-come,  first-served  basis  (may  be  limited 
for  some  programs).  For  purposes  of  registration,  staff  of  county  medical  societies  are  considered  members.  Please 
indicate  the  number  of  attendees  for  each  function,  even  if  there  is  no  charge,  so  that  we  may  be  cost  efficient  with 
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As  a member,  you  and  one  guest  are  entitled  to  attend  the  complimentary  events  at  no  charge.  Please  indicate 
the  number  of  additional  guests  at  the  bottom  of  this  form  and  enclose  your  check. 


Complimentary  events  open  to  all  members: 

Thursday,  September  9 

6:00  pm  Reception:  It's  a Jungle  Out  There 
7:00  pm  Dinner:  It's  a Jungle  Out  There 
Friday,  September  10 

5:30  pm  Exhibitor  Reception 

6:30  pm  Women  in  Medicine  Reception 

Saturday,  September  1 1 

7:00  am  Educational  Program  Continental  Breakfast 

8:00  am  Educational  Program 

7:00  pm  President's  Dinner  Dance  (please  select  menu  below) 
Beef  Dinner 
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8:30  pm  Copic  Dessert  Reception 


member 

member 

member 

member 

member 

member 

member 

member 

member 


a 

guest  □ 
guest  U 

a 

guest  □ 
guest  U 

□ 

□ 

guest  □ 
guest  U 

□ 

a 

guest  □ 
guest  U 
guest  U 

Non-Complimentary  Events:  Cost  Number 

Friday,  September  10 

8:30  am  CMSA  BOD  Breakfast $12  each  

12  Noon  COMPAC/CMSA  Luncheon $15  each 

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Total  for  Non-Complimentary  Reservations  $ 

Additional  Reservations  (other  than  member  + 1 guest): 

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Total  for  Additional  Reservations  $ 


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$10  OFF 


Where  all  the  miles 
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Examine  the  special  offer  from  Alamo.  Association 
members  can  enjoy  a $10  OFF  ANY  WEEKLY 
RENTAL  OR  FREE  WEEKEND  DAY  with  Alamo’s 
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Code  BY  and  ID#  BY93235 when 

making  reservations. 


• Valid  for  $10  OFF  ANY  WEEKLY  RENTAL  on  a compact  car  or  above 
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• One  certificate  per  rental,  not  valid  with  any  other  offers.  Must  be  presented  at  the  Alamo 
counter  on  arrival.  Certificate  may  only  be  redeemed  for  the  basic  rate  of  the  car  rental  which 
does  not  include  taxes  and  other  optional  items.  Once  redeemed,  this  certificate  is  void. 

A 24-hour  advance  reservation  is  required.  Valid  on  Rate  Code  BY  only. 

■ This  certificate  and  the  car  rental  pursuant  to  it  are  subject  to  Alamo's  conditions  at  time  of 
rental.  Valid  at  Alamo  locations  in  the  U.S.A.  only.  The  maximum  value  of  this  certificate 
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• This  certificate  and  the  car  rental  pursuant  to  it  are  subject  to  Alamo's  conditions  at  time 
of  rental.  Valid  at  locations  in  the  U.S.A.  only. 

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232 


Colorado  Medicine  for  July,  1993 


Protection  this  good  comes  from  those  who 
know  you  best.  Who  are  there  to  look  out  for 
your  best  interests.  Who  understand  your 
special  needs. 

That’s  why  Colorado  physicians  and 
surgeons  can  put  their  trust  in  The  Doctors’ 
Company.  We’re  the  largest  doctor-owned, 
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with  over  16,800  member-doctors 
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doctors  practice  better  medicine  since  1976. 

We  are  rated  “A  + ” (Superior)  by  A.M.  Best 
Company,  independent  analysts. 

The  Doctors’  Company  and  our  local 
Colorado  agents  provide  a level  of  service  that 
promises  to  ensure  your  peace  of  mind. 

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Colorado  Medicine  for  July,  1993 


233 


Health  Care  Reform 


Medicine  in  the  Twenty-First  Century 

Place:  PiAA  meeting,  Washington,  D.  C. 

Date:  June  3,  1993 

Speaker:  Glen  F.  Auckerman,  M.D.,  Chairman,  Department  of  Family  Practice,  West  Virginia  School  of  Medicine; 
Alternate  Delegate,  AMA;  Previously  Chairman  (4  months)  of  Clinton's  Health  Care  Task  Force; 

26  years  as  Family  Practitioner,  Ohio. 


Clinton  health  care  reform  package 


A report  from  an  insider  on  the 


Significance:  Dr.  Aucker- 
man is  one  of  the  rela- 
tively few  people  who 
have  read  all  35  sections 
of  the  final  Health  Reform 
Task  Force  report , for- 
warded to  the  President. 

He  is  also  one  of  the  twenty  odd 
people  who  has  been  asked  by  the 
Administration  to  tour  the  country, 
explaining  the  proposal.  He  was 
quite  open  about  the  fact  that  the 
recommendations  may  be  changed 
significantly  by  Clinton  before  being 
presented  to  Congress  in  September. 
Every  organization  (including  the 
AMA)  has  a health  care  reform  plan 
but  the  only  one  which  really  counts 
is  the  one  which  emerges  from  the 
House-Senate  Joint  Conference 
Committee.  This  plan  may  or  may 
not  bear  any  resemblance  to  the 
recommendations  outlined  below. 
This  summary  focuses  on  profes- 
sional liability  since  this  was  Dr. 
Auckerman's  assignment  and  the 
main  interest  of  his  audience. 


Synopsis:  The  Task  Force  is  recom- 
mending that  "enterprise  liability"  be 
substituted  for  the  current  profes- 
sional liability  system.  Under 
enterprise  liability,  individual 
physicians  and  hospitals  could  no 
longer  be  sued  for  malpractice.  Total 
liability  would  be  assumed  by  the 
"enterprise",  which,  in  most  cases, 
would  be  the  Accountable  Health 
Plan  (AHP).  This  is  the  consortium  of 
physicians,  hospitals,  and  other 
providers  who  would  be  responsible 
for  the  delivery  of  health  care  to  the 
members  of  the  Health  Alliance 
(previously  known  as  the  Health 
Care  Cooperative  - H I PIC).  Occa- 
sionally it  was  implied  that  the 
various  AHPs  would  compete  with 
each  other  to  contract  with  the 
Health  Alliance.  More  often  it  was 
stated  that  each  AHP  would  be 
responsible  for  the  behavior  of  all 
providers  and  responsible  for  the 
health  of  all  of  the  citizens  who  lived 
in  its  area,  region  or  state. 

Enterprise  liability  is  seen  as  the 
cornerstone  for  the  entire  proposal 
since  it  is  assumed  that  it  would 
allow  physicians  to  return  to  making 
decisions  based  on  "clinical  judg- 
ment". This  would  eliminate 
defensive  medicine  and  decrease  the 
use  of  "high  tech"  medicine.  The 
Task  Force  is  estimating  that  55%  of 
the  cost  of  medical  care  can  be 
attributed  to  defensive  medicine. 
Therefore,  in  the  proposal,  enterprise 
liability  becomes  a crucial  cost 
containment  device.  This,  despite  the 
fact  that  it  is  anticipated  individual 
damage  awards  will  increase  by  a 
factor  of  30  or  40.  Each  state  will  be 
the  "payer  of  last  resort"  and  thus 
would  ultimately  underwrite  the 


AHP's  liability.  Each  state  would 
then  have  the  choice  of  passing  strict 
tort  reform  legislation  or  increasing 
taxes. 

Enterprise  liability  is  seen  as  the 
major  factor  which  will  entice 
physicians  into  joining  the  AHP. 

80%  are  expected  to  join  and  no 
physician  will  be  excluded  except  by 
his/her  choice.  The  other  20%  will 
not  be  covered  by  enterprise  liability 
and  it  is  anticipated  (?-hoped)  that 
their  malpractice  premiums  will 
increase  significantly. 

It  will  be  up  to  the  AHP  to 
discipline  and/or  terminate  physi- 
cians practicing  poor  quality  medi- 
cine but,  at  the  same  time,  the  AHP 
will  be  held  accountable  for  the 
number  of  physicians  it  terminates. 
Guidelines,  based  on  outcome 
studies,  will  be  developed  for  all 
common  and  uncommon  illness.  The 
AHP  will  not  be  held  legally  or 
financially  responsible  for  bad 
outcomes  if  physicians  adhere  to  the 
guidelines  (current  law  in  Maine).  If 
the  AHP  stops  paying  physicians  for 
what  they  do  that  does  not  work 
(procedures,  tests,  etc.),  the  plan 
assumes  that  they  will  stop  doing 
them. 

The  debate  is  no  longer  focused 
on  whether  we  should  have  health 
care  reform.  The  issues  have  be- 
come: 

1 . How  will  it  be  paid  for? 

2.  How  rapidly  will  it  be  imple- 
mented? 

3.  Will  there  be  restrictions  on  what 
kind  of  plans  people  can  buy  or 
which  doctor  they  see? 

4.  How  much  are  we  willing  to 
restrict  the  privileged  few  for  the 
benefit  of  the  unprivileged  many? 


234 


Colorado  Medicine  for  July,  1993 


From  the  Annual  Meeting  of  the 

Physician  Insurers  Association  of  America  (PIAA) 

by  Frederick  A.  Lewis , Jr,  M.D. 
Member,  Board  of  Directors 
Copic  Insurance  Company 


Health  care  reform  has  already 
been  started  by  many  organizations 
and  in  many  states.  Forty  states 
(including  Colorado)  are  currently 
involved  in  health  care  reform.  The 
states  will  be  allowed  and  encour- 
aged to  set  up  their  own  system  as 
long  as  it  meets  certain  federal 
standards.  A conscious  effort  will  be 
made  to  reduce  federal  bureaucracy 
and  transfer  authority,  bureaucracy 
and  fiscal  responsibility  to  the  states. 
In  this  manner,  Clinton  will  be  able 
to  say,  truthfully,  that  he  reduced  the 
national  debt  when  he  runs  in  1 996. 

There  are  a large  number  of 
targetable  problems  such  as  infant 
mortality,  infant  nutrition,  lack  of 
prenatal  care,  late  diagnosis  of  breast 
cancer,  etc.  The  National  Health 
Board  will  be  able  to  tell  each  state 
(AHP)  "this  is  your  target  for  the  year 
- we  expect  that  you  will  get  the 
incidence  down  to  this  level  - we 
don't  care  how  you  do  it,  just  do  it.  If 
you  don't,  you  won't  be  the  AHP 
next  year  and  you  will  receive  no 
federal  funding." 

Each  state,  for  example,  will  be 
told  how  much  they  spent  from  all 
sources,  for  both  compensated  and 
uncompensated  health  care  in  the 
preceding  year.  They  may  be  told 
that  their  target  for  next  year  is  to 
spend  the  same  amount;  however,  in 
order  to  have  your  AHP  and  Health 
Alliance  re-authorized  by  the  federal 
government  and  continue  to  receive 
federal  funds,  you  will  have  to  figure 
out  how  you  are  going  to  cover 
everyone  in  your  state  for  the  same 
amount.  In  addition,  there  can  be  no 
increase  in  your  infant  mortality  rate, 
incidence  of  AIDS,  drug  addiction, 
etc. 


Clinton's  health  care  plan  cannot 
be  delivered  by  physicians  and  the 
healers  of  the  twenty-first  century 
will  probably  not  be  physicians.  The 
Task  Force  estimates  that  the  country 
is  at  least  8 to  1 oversupplied  with 
specialists  and  the  number  may  be 
1 6 to  1 . In  ten  to  fifteen  years  there 
will  be  a large  number  of  unem- 
ployed physicians  and  the  charges 
for  procedures  will  be  markedly 
reduced. 

There  is  a concept  in  law  called 
"deemed  prescriptive  authority  by 
federal  preemption".  If  states  are 
unable  to  supply  enough  primary 
care  physicians  to  meet  the  need, 
nurses  will  be  "deemed"  to  be  fully 
licensed  physicians  for  "x"  number 
of  years. 

Medical  schools  are  already 
cutting  high  priced  specialty  resi- 
dency slots  and  increasing  the 
number  of  family  practice  slots. 
Programs  are  already  being  devised 
to  retrain  specialists  to  be  generalists. 
The  target  is  to  retrain  one-third  of 
the  specialists.  Another  problem  is 
that  non-physician  health  care 
practitioners  are  specialized  almost 
to  the  same  degree  as  physicians. 
They  will  also  be  retrained.  The 
program  will: 

• Not  be  a single  payer  system  but 
will  look  like  one. 

• Not  be  a single  managed  care 
system  but  will  look  like  one. 

• In  terms  of  managed  competition 
v.  managed  cooperation  - will  look 
like  competition  but  operate  more 
on  basis  of  cooperation. 

The  plan  takes  care  of  women 
and  children,  dysfunctional  people, 
and  people  with  chronic  illness. 
There's  not  much  in  the  program  for 


Clinton  will  be  able  to  say, 
truthfully,  that  he  reduced 
the  national  debt  when  he 
runs  in  1 996. 


white  males  - this  group  is  not 
perceived  as  having  been  neglected. 

Big  Brother  is  not  going  to  do  it 
to  you.  The  federal  government  is 
not  seen  as  an  effective  agent  to 
bring  about  major  change.  The 
changes  are  in  the  process  of  being 
made  by  hospitals  and  hospital  staffs. 
Look  out  when  you  begin  to  see 
hospitals  and  PPOs  doing  "economic 
credentialing"  and  you  see  hospitals 
buying  family  practices  - health 
reform  is  already  on  its  way. 

"The  group  that  allows  old 
visions  to  cloud  their  mission  will 
lose  out  in  the  world  we  are  going 
to."  We  need  to  stop  the  Paul 
Masson  view  - "We  will  solve  no 
problem  before  its  time." 


P.  S.  Please  do  not  shoot  the  mes- 
senger. The  AMA,  PIAA  and  Copic 
Insurance  Company,  are  not  in  fa- 
vor of  "enterprise  liability".  Dr. 
Auckerman,  however,  appears  to 
be  an  enthusiastic  supporter  of  the 
program. 


Colorado  Medicine  for  July,  1993 


235 


Health  Care  Reform 

Enterprise  Liability:  Reaction 


by  Bill  Pierson,  Managing  Editor 
Colorado  Medicine 


Larry  Thrower,  President/COO 
Copic  Insurance  Company 
President,  PIAA 

Colorado  Medicine  editorial  offices 
are  "just  down  the  hall " from  the 
newly-elected  President  of  the  Phy- 
sician Insurers  Association  of 
America,  Larry  Thrower,  also  Presi- 
dent and  COO  of  Copic  Insurance 
Co.  His  election  was,  in  fact,  at  the 
same  meeting  from  which  Dr. 
Frederick  Lewis  reported  on  Dr. 
Glen  Auckerman 's  discourse  on  this 
subject.  C/M  asked  Thrower,  his 
views  from  the  PIAA  perspective 
about  "enterprise  liability". 


Thrower:  Dr.  Lewis  correctly  notes 
the  emphasis  given  the  "enterprise 
liability"  in  the  administration's 
health  reform  proposals,  but  as  we 
speak  that  emphasis  may  have  been 
withdrawn  or  modified. 

C/M:  Why  do  you  think  that  may  be 
happening? 

Thrower:  Because  of  the  widespread 
opposition  to  such  an  untested 
concept.  Typical  of  the  letter  you 
have  reprinted  in  this  magazine  from 
the  AMA  to  the  Clinton  Health  Care 
Reform  Task  Force.  I believe  you 
said  the  letter  was  signed  by  over 
1 50  organizations.  At  our  PIAA 
meeting  there  was  a broad-based 


concern  about  "enterprise 
liability"  because  of  the  potential 
problems  the  insurers  see. 

C/M  : What  are  these  potential 
problems? 

Thrower:  At  this  stage,  "enterprise 
liability"  is  just  an  academic  concept, 
largely  untested,  with  sweeping  and 
unknown  effects  on  the  resolution  of 
patient/physician  disputes. 

C/M  : Would  this  be  typical  of  some 
malpractice  incident  or  complaint? 

Thrower:  Yes.  And  then  there's  the 
transfer  of  liability  to  some  faceless 
administrative  organization,  rather 
than  the  liability  of  the  individual 
physician.  This  is  viewed  as  remov- 
ing one  of  the  deterrent  effects  now 
in  existence  as  patients  contemplate 
litigation  against  "their  own  doctor". 

C/M:  How  does  that  work? 

Thrower:  It  is  much  more  difficult  for 
persons  to  file  a complaint  or  a 
lawsuit  against  an  individual  physi- 
cian than  it  is  to  bring  charges 
against  an  impersonal  organization. 

C/M  : What  are  some  of  the  other 
factors  that  concern  the  insurers? 

Thrower:  Settlement  decisions  under 
enterprise  liability  are  much  more 
likely  to  be  made  on  the  basis  of 
economic  factors  only.  This  would 
be  a full-field  reversal  of  the  posture 
of  PIAA  insurers,  which  is  to  vigor- 
ously defend  good  medical  care  and 
against  all  claims  which  are  deemed 
to  be  without  merit  or  frivolous. 


C/M:  ""Enterprise  liability"  also 
sounds  as  though  it  de-personalizes 
the  physician's  role  in  medical 
practice. 

Thrower:  That's  true.  There  will  be  a 
worrisome  transfer  of  credentials  and 
privileges  decisions  to  Health 
Alliances  (or  other  administrative 
organizations)  with  the  affected 
physician  potentially  left  out  of  the 
decisions  to  defend  or  to  settle.  It 
could  also  mean  that  the  physician's 
fitness  to  practice  will  be  judged  on 
the  basis  of  those  very  defend/settle 
decisions. 

C/M  : We've  heard  a lot  of  talk  about 
"tort  reform"  being  part  of  the  total 
health  care  reform  package,  but  no 
hard  evidence  has  emerged  yet. 
That's  true  of  the  whole  reform 
package:  there's  no  hard  evidence 
that  such  a program  does  exist.  But 
what  about  tort  reform? 

Thrower:  The  elements  of  tort  reform 
which  will  finally  be  included  in 
federal  health  reform  remain  clouded 
— both  because  of  the  issues  we've 
noted  here  and  because  of  the  highly 
influential  plaintiff  lawyer  organiza- 
tions which  are  vigorously  resisting 
any  statutory  reforms  which  mirror 
California's  MICRA  or  the  Health 
Care  Availability  Act  enacted  by 
Colorado  in  1988.  As  the  liability 
elements  of  health  care  reform 
evolve,  PIAA  and  Copic  Insurance 
Company  will  make  every  attempt  to 
both  report  them  to  the  physicians 
and  to  interpret  their  influence  on 
the  doctor's  practice. 

| c/m\ 


236 


Colorado  Medicine  for  July,  1993 


TRUE  OR  FALSE? 

1.  Was  practice  income  higher  for  most  Colorado  physicians  in  1992  than 
in  1988? 

2.  Was  personal  income  higher  for  most  Colorado  physicians  in  1992  than 
in  1988? 

3.  Was  practice  income  higher  in  1 992  and  personal  income  higher  in  1 988 
for  most  Colorado  physicians? 

If  you  answered  True  to  1 and  2 and  False  for  3,  you  may  be  in  for  quite  a 
surprise.  We  believe  the  typical  financial  scenario  for  most  Colorado 
physicians  is  best  expressed  by  a True  answer  to  question  3. 

What  IS  true  about  your  practice  and  personal  income  when  you  compare 
1992  and  1988  bottom  lines?  Do  you  know  why  you  achieved  those 
particular  results?  Do  you  know  what  you  must  do  to  improve  your  future 
financial  position? 

We  would  like  to  help  all  Colorado  physicians  better  understand  the 
financial  dynamics  of  their  medical  practices  and  how  their  practices 
compare  to  others  in  this  Colorado  by  medical  specialty  and  geographic 
area.  Both  our  services  and  our  survey  are  conducted  in  a completely 
confidential  manner.  We  urge  you  to  participate  in  this  important  program. 
Get  the  facts!  Please  mail  the  coupon  or  call  303-290-9191  to  receive  a 
$75.00  discount  on  your  CONFIDENTIAL  PRACTICE  PROFILE. 

INTRODUCTORY  OFFER  - SAVE  $75.00! 

Yes,  I am  concerned  about  my  financial  situation  and  would  like 
to  know  how  to  enhance  my  practice  and  personal  income. 

Name 

Specialty 

Address 

City  State Zip  Code 

Telephone Best  time  to  call  

MAIL  TO:  DAVID  SCHORE  & PARTNERS 

8200  South  Quebec  Street,  Suite  A-290,  Englewood,  CO  80112 


OFFICIAL  CALL  FOR  NOMINATIONS 

The  Colorado  Medical  Society  Nominating  Committee  is  seeking  nominations 
for  the  following  elected  positions  for  the  1993-94  term  of  office. 

PRESIDENT-ELECT  (from  out-state) 

SPEAKER  OF  THE  HOUSE 

VICE  SPEAKER  OF  THE  HOUSE 

AMA  DELEGATE  (two) 

AMA  ALTERNATE  DELGATE  (two) 

Please  contact  Dr.  Ronald  E.  Tegtmeier,  Chair,  at  (303))278-2600  or  Mary  Lee  Johnston,  CMS 
staff,  1-800-654-5653  or  (303)779 — 5455  with  names  of  interested  persons.  The  Nominating 
Committee  will  be  meeting  during  the  President's  Planning  Conference  in  Longmont,  Colo- 
rado on  July  16-1  7,  1993  to  interview  prospective  candidates  or  at  another  time  if  necessary. 


Physician 

Recognition 

Awards 

The  Colorado  Medical  Society 
joins  the  American  Medical  Associa- 
tion in  recognizing  the  following  phy- 
sicians for  their  dedication  to  excel- 
lence in  the  profession  of  medicine, 
as  demonstrated  in  their  commitment 
to  continuing  medical  education. 
David  M.  Abbey 
Richard  F.  Bedell 
George  F.  Cresswell 
Robert  A.  Dragoo 
Thomas  M.  Golbert 
Lawrence  N.  Gorab 
Dudley  H.  Kersey 
John  S.  Lemley 
John  C.  Maisel 
Benjamin.  Martinez 
Donald  K.  McClure 
Solbritt  E S.  Murphy 
Ronald  L.  Peveto 
Sharon  K.  Schaefer 
Marc  J.  Sorkin 
Duane  R.  Spaulding 
Lisa  Marie  Toepp 
Steven  M.  Traina 
Diane  L.  Wing 


Colorado  Medicine  for  July,  1993 


237 


pecialty  Practice  News 

Colorado  Society  of  Internal  Medicine 

Survey  of  Colorado's  Internists  completed 


The  only  collection  of  internal  medicine  demographics  and  economics  for  Colorado  in  1993 


. . $48, 7 00  of  their  billed 
charges  were  written  off 
last  year. . . " 


The  Colorado  Society  of  Internal 
Medicine  has  announced  the 
completion  of  an  all  member  survey. 
The  Society  has  286  members, 
representing  both  general  internal 
medicine  specialists  and  medical 
subspecialists.  The  survey  elicited  a 
superb  response,  with  103  general- 
ists and  75  subspecialists  returning 
their  forms  for  tabulation,  represent- 
ing a 62%  response  rate. 

Colorado's  internists  are  prima- 
rily an  urban  specialty.  90%  of  the 
general  internists  reported  their 
practices  as  being  urban,  while  96% 
of  the  subspecialists  are  urban 
dwellers. 

Colorado's  general  internists 
reported  a median  income  of 
$108,000  during  the  past  year.  65% 
stated  that  their  income  as  compared 
to  the  previous  year  had  either 
remained  the  same  or  decreased. 

The  generalists  also  reported  an 
average  work  week  of  68.8  hours.  A 
calculation  of  annualized  work 
suggests  an  average  hourly  rate  of 
$30/hour.  The  estimates  of  work 
excluded  time  spent  on  call,  but  did 
include  time  spent  performing 
paperwork.  The  latter  was  14.6 
hours  per  week,  representing  21%  of 
the  general  internists  work  time. 

Colorado's  medical 
subspecialists  fared  better  in  terms  of 
income  with  49%  reporting  their 
annual  income  as  greater  than 
$1  50,000.  Their  average  work  week 
was  slightly  shorter  at  59.7  hours,  of 
which  19%  was  devoted  to  paper 
work  completion.  81  % of  the 
subspecialty  internists  reported  that 
their  incomes  had  either  flattened  or 
declined  compared  to  the  previous 
year. 


The  average  general  internist 
reported  taking  16  vacation  days  last 
year,  while  medical  subspecialists 
reported  taking  20.6  days. 

The  average  general  internist 
also  reported  that  $48,100  of  their 
billed  charges  were  written  off  last 
year  because  of  contractural  relation- 
ships with  insurance  companies  and 
with  Medicare  or  Medicaid.  Addi- 
tionally, the  average  general  internist 
reported  that  $1  5,300  worth  of  free 
care  was  rendered  to  patients  with 
no  insurance  or  other  means  of 
payment. 

Medical  subspecialists  reported 
an  average  write  off  of  $77,800  from 
billed  charges.  Additionally  the 
average  subspecialist  provided 
$25,700  of  free  care  to  medical 
indigent  patients. 

Economic  policies  appear  to 
have  some  influence  on  access  to 
internists'  offices.  Because  of  the 
increasing  regulation  arising  from 
OSHA  inspections  and  Clinical 
Laboratories  improvement  Act 
(CLIA),  28%  of  the  general  internists 
and  20%  of  subspecialists  reported 
closure  of  their  office  laboratories. 
The  percentage  of  closures  is  actu- 
ally higher  because  the  survey  did 
not  ask  how  many  offices  had  never 
had  a laboratory.  The  closure  of 
office  laboratories,  while  reflecting 
cost  savings  to  the  health  care 
system,  reflects  a greater  difficulty  for 
patients  who  may  have  to  travel  to 
other  sites  for  laboratory  tests  or  have 
to  wait  for  a diagnosis  because  tests 
normally  run  on  a "stat"  basis  are 
shipped  to  another  location  for 
processing.  Lack  of  access  to  stat 
laboratory  not  only  delays  clinical 
decision-making,  but  also  contrib- 


238 


Colorado  Medicine  for  July,  1993 


r~r^  * i 

internal  medicine 


by  the  Executive  Committee  of  the  Colorado  Society  of  Internal  Medicine 

David  A.  Claassen,  M.D.,  Chairman  and  President;  David  M.  Abbey,  M.D;  James  F.  Bush,  M.D; 

Jerry  A.  Chase,  M.D;  Janet  E.  Shemmel,  M.D;  Robert  D.  McCartney,  M.D. 


utes  to  more  time  on  spent  on  the 
telephone,  potential  errors,  and 
greater  difficulty  in  assuring  that 
patients  understand  the  doctor's 
recommendations. 

While  the  majority  of  internists 
and  subspecialists  accept  new 
patients,  only  64%  of  generalists  and 
85%  of  subspecialists  are  accepting 
new  Medicare  patients.  Reasons  for 
this  include  a relative  low  reimburse- 
ment for  Medicare  services,  the 
greater  complexity  of  the  Medicare 
population,  and  the  soaring  over- 
head of  the  internists'  office.  The 
latter  is  generally  in  excess  of  50%  of 
collected  revenues.  The  lot  of 
patients  with  Medicaid  is  less 
favorable,  with  only  28%  of  general- 
ists and  61  % of  subspecialists  willing 
to  sign  on  to  provide  this  population 
ongoing  care. 

Internists  reported  a willingness 
to  provide  long  term  care  to  patients 
in  nursing  homes.  73%  of  general 
internists  and  1 7%  of  subspecialty 
internists  currently  have  patients  in 
Colorado  nursing  facilities. 

45%  of  the  general  internists  and 
medical  subspecialists  reported  that 
they  donated  a part  of  their  time 
teaching  medical  students  as  part  of 
their  daily  work.  This  service  is 
made  to  the  Colorado  public  free  of 
charge  and  contributes  to  the 
mission  of  the  University  of  Colorado 
School  of  Medicine. 

When  inquiries  were  made 
about  job  satisfaction,  there  was  a 
negative  flavor  discovered.  Only 
77%  of  general  internists  stated  that 
they  would  again  choose  medicine 
as  a career  if  starting  over  today. 

Only  44%  stated  that  they  would 
again  choose  to  be  a general  inter- 


nist. Only  30%  state  that  they  would 
advise  their  children  to  pursue  a 
career  in  internal  medicine.  Only 
35%  of  medical  subspecialists  would 
similarly  urge  their  child  into  a 
internal  medicine  subspecialty.  66% 
of  general  internists  and  72%  of 
medical  subspecialists  stated  that 
given  the  opportunity,  they  would 
leave  direct  patient  care  for  some 
other  field  of  endeavor  within 
medicine. 

Internists  in  general  expressed 
dissatisfaction  with  medical  practice. 
The  most  commonly  cited  reasons 
were  long  hours  away  from  family, 
the  increasing  burden  of  paper  work, 
the  intrusion  of  government  and 
third-party  payors  into  practice  and 
clinical  decision-making,  destruction 
of  the  doctor-patient  relationship, 
negative  insinuations  about  the 
physicians'  character,  and  pressures 
from  the  legal  system  for  defensive 
medical  practice. 

On  a positive  note,  however, 
almost  all  physicians  reported  that 
they  found  the  relationships  and 
friendships  with  their  patients  as  the 
most  rewarding  aspect  of  medicine. 
Other  common  answers  included  the 
intellectual  stimulation  of  clinical 
practice,  the  autonomy  of  individual 
practice,  and  the  col legial ity  of  other 
physicians. 


" Only  44%  stated  that 
they  would  again  choose 
to  be  a general  internist. " 


Colorado  Medicine  for  July,  1993 


239 


eople-to-Pepple 

(Thoracic  and  Cardiovascular  surgeons)  visit  Viet  Nam 
and  Southeast  Asia 


...an  enormous 
amount  of  Pathology 
awaited  care  with  the 
resources  terribly  limited. 


Early  this  year,  my  wife, 
and  I were  the  delegahj 
leaders  for  a grouper 1 7 
physicians,  2rrdfses,  and  10 
spouses  tpWisit  hospitals 
and  medical  schools  in 
utheast  Asia  with  the 
focus  being  on  spending  a 
week  in  Vietnam.  The  tour 
was  arranged  through  the 
auspices  of  the  American 
Citizen  Ambassador 
(People-to-People  Program). 
Prior  to  departing  San 
Francisco,  the  group 
attended  a briefing  session 
on  Vietnam  by  Dr.  Eric 
Crystal,  a Professor  of  Far 
Eastern  Affairs  from  the  University  of 
California,  Berkeley.  Our  group 
constituted  the  largest  group  of 
organized  physicians  to  visit  Vietnam 
since  the  hostilities.  The  entire  tour 
required  approximately  one  year  of 
pre-planning  including  contacts  with 
prominent  cardiothoracic  surgeons 
in  Southeast  Asia. 

Our  first  stop  was  a visit  to 
Gleneagles  Hospital  in  Singapore 
which  was  a first  class  institution  as 
was  the  National  Heart  Center  in 
Kuala  Lumpur,  Malaysia. 

We  spent  a week  in  Vietnam 
visiting  the  key  centers  - Hanoi,  Da 
Nang,  Hue,  and  Saigon  (Ho  Chi 
Minh  City).  In  every  instance  we 
were  treated  with  the  utmost  of 
hospitality  and  friendship.  There  was 
never  a single  mention  of  any 
previous  problems  that  existed 
between  our  countries  and,  indeed, 
the  Vietnamese  pleaded  for  an  early 
relief  of  the  American  embargo.  It 
was  obvious  that  the  Japanese  and 


Korean  business  people  are  into 
Vietnam  in  great  numbers  because  of 
the  great  promise  for  development  of 
resources  in  the  country. 

Doctor  Ted  Ning  (Theodore  C. 
Ning,  Jr.,  Wheat  Ridge,  Urological 
Surgery)  and  his  group  of  Friendship 
Bridge*  have  performed  an  excep- 
tionally good  job  of  improving 
relationships  between  our  two 
countries  usually  on  an  individual 
and  small  group  basis.  We  have 
shared  their  concerns  and  interests 
regarding  the  Vietnamese  people. 

A few  comments  about  the 
country  in  general.  There  are  ap- 
proximately 69  million  people  in 
Vietnam  of  whom  2 million  are 
Communist.  Five  million  people  live 
in  Hanoi.  It  was  obvious  from  the 
outset  that  Hanoi,  the  political 
capital  of  the  country,  is  a very 
conservative  city  almost  dreary  in  its 
appearance  and  undoubtedly  under 
a fairly  heavy  political  domination. 
This  is  in  striking  contrast  to  Saigon 
which  is  a much  more  colorful, 
energetic,  lively  city  reminding  one 
of  Hong  Kong  approximately  40 
years  ago  and  one  has  the  sense  of  a 
burgeoning  city  full  of  enterprise  and 
hard  work.  There  is  a good  deal 
more  building  going  on  in  Saigon 
than  Hanoi.  In  all  of  Vietnam  there  is 
said  to  be  2 million  bicycles  and  1 
million  Honda  motor  bikes.  Approxi- 
mately 50%  of  the  Vietnamese 
households  have  television  and  40% 
have  VCR's.  This  is  important 
because  a movie  house  admission 
will  cost  about  $3.00  whereas  a 3 
hour  VCR  tape  can  be  rented  for  30 
cents.  In  Ho  Chi  Minh  City  the 
unemployment  rate  is  about  30%. 


240 


Colorado  Medicine  for  July,  1993 


W.  Gerald  Rainer,  M.D. 
Thoracic  and  Cardiovascular  Surgry 
Denver,  CO 


In  Hanoi,  we  visited  Viet  Due 
Hospital  and  were  impressed  with 
the  impoverished  state  of  the  medi- 
cal institutions  in  Hanoi.  The  patients 
were  three  to  a bed  and  an  enor- 
mous amount  of  Pathology  awaited 
care  with  the  resources  terribly 
limited.  There  is  very  little  in  the  way 
of  sophisticated  (as  we  know  it) 
electronics  machinery  but  a great 
need  for  basic  implements  such  as 
surgical  instruments,  suture  material, 
and  even  IV  tubing  administration 
sets.  The  library  at  Hanoi  Medical 
College  is  very  bare  with  a few  old 
(circa  1900)  books  in  German  and 
other  languages.  Over  the  last 
several  decades  the  Vietnamese  have 
depended  heavily  upon  support  from 
some  of  the  Eastern  European 
countries  such  as  Czechoslovakia 
and  Poland.  Some  of  the  equipment 
such  as  x-ray  machinery  from  these 
countries  is  very  much  out  of  date 
and  most  of  the  time  in  a state  of 
gross  disrepair. 

Da  Nang  and  Hue  were  cities  of 
interest  to  visit  primarily  because  of 
their  military  importance,  three  of 
the  members  of  our  delegation 
having  spent  time  in  the  military  in 
Vietnam.  During  the  2 1/2  hour  bus 
ride  from  Da  Nang  to  Hue  it  was 
obvious  that  the  countryside  is 
beautiful,  lush,  and  green  where  the 
methods  of  farming  now  have 
remained  unchanged  for  over  two 
thousand  years.  There  is  still  a very 
high  incidence  of  liver  malignancy 
secondary  to  the  liver  flukes  from  the 
rice  paddies  and,  indeed,  this  is  one 
of  the  leading  causes  of  death.  There 
is  a fair  amount  of  alcohol  abuse  and 
opium  use  in  the  mountains  in 
Northern  Vietnam  where  it  borders 


on  Cambodia. 

In  Saigon,  we  were  fortunate  to 
be  able  to  visit  the  National  Cancer 
Center  and  the  local  Peoples' 

Hospital  (Binh  Dan  Hospital)  which 
is  comparable  to  our  Denver  General 
Hospital.  Although  there  is  a new 
wing  of  the  Binh  Dan  Hospital,  there 
are  8 new  operating  rooms  that  are 
totally  empty  because  of  lack  of 
equipment.**  Several  members  of 
our  delegation  brought  basic  sup- 
plies to  donate  to  hospitals  in  both 
Hanoi  and  Saigon  and  current  copies 
of  Zollinger's  ATLAS  OF  SURGICAL 
OPERATIONS  were  presented  to 
each  of  the  hospitals  as  gifts  from  the 
American  Delegation. 

Again,  our  entire  group  was 
treated  with  the  utmost  of  hospitality 
and  respect.  We  had  scientific 
interchanges  with  the  staff  members 
of  all  of  the  hospitals  and  institutions 
that  we  visited.  As  much  as  we 
attempted  to  share  our  knowledge 
with  the  Vietnamese,  we  probably 
profited  much  more  from  having 
been  able  to  see  first  hand  their 
plight,  their  needs,  and  their  enor- 
mous resourcefulness. 


*see  A Friendship  Bridge  from  the  United 
States  to  Viet  Nam,  COLORADO  MEDICINE 
VOL  90,  No.  4,  April,  '93,  ppl  48-1  50. 

**For  anyone  wishing  to  contribute  or  donate 
medical  equipment  or  supplies,  contact 
Friendship  Bridge,  33424  Deep  Forest  Road, 
Evergreen,  CO  80439,  phone  (303)  421-1203. 


" ...a  very  high  inci- 
dence of  liver  malignancy 
secondary  to  the  liver 
flukes  from  the  rice  pad- 
dies. " 


Colorado  Medicine  tor  July,  1993 


241 


MEDICAL  NEWS 


CMS  works  with  ASSIST 
to  curb  health  care 
provider  smoking 

The  American  Stop  Smoking  Inter- 
vention Study  (ASSIST)  will  begin 
funding  smoking  control  activities 
this  fall  in  Colorado.  The  Health  Care 
Committee  for  the  project  has 
developed  an  action  plan  that 
includes  three  major  objectives  for 
health  care  facilities  and  providers. 
The  first  objective  has  to  do  with 
training  health  care  providers  to 
conduct  quick  office  interventions  for 
tobacco  cessation;  the  second 
objective  encourages  all  public  and 
private  health  care  facilities  to 
implement  tobacco  free  policies;  and 
the  third  objective  works  to  involve 
pharmacists  in  the  support  of  patients 
attempting  to  quit  using  tobacco. 

As  an  organizational  member  of 
the  ASSIST  Alliance,  the  Colorado 
Medical  Society  is  invited  to  have  a 
member  participate  on  this  commit- 
tee. Your  ideas  on  ways  to  reach 
health  care  providers  or  problems 
with  current  methods  of  office 
interventions  would  be  helpful. 

Many  physicians  are  taking  the 
lead  in  communities  in  Colorado  by 
being  spokespersons  for  better 
tobacco  cessation  training  for  health 
care  providers  and  eliminating  the 
tobacco  companies'  access  to  youth 
in  local  communities.  Call  Gloria 
Latimer  at  (303)  692-251  3. 


American  Lung 
Association  calls  for 
action 

The  Colorado  Chapter  of  the 
American  Lung  Association  sent  out 
an  appeal  to  Denverites  to  support 
proposed  Denver  ordinance 
changes.  Denver  residents  and  non- 
residents who  use  Denver  facilities 
(Mile  High  Stadium,  airport,  restau- 
rants, etc.)  are  asked  to  let  Denver 
City  Council  members  know  theirr 
opinion  on  exposure  to  environmen- 
tal tobacco  smoke  (ETS). 

The  recent  EPA  report  identifying 
ETS  as  a class  A carcinogen  for 
which  there  is  no  safe  level  of 
exposure,  and  new  scientific  evi- 
dence indicating  that  environmental 
tobacco  smoke  kills  an  estimated 
53,000  nonsmokers  every  year  have 
prompted  proposed  changes  which 
would  strengthen  the  current  Denver 
ordinance  on  tobacco  smoke. 

The  new  changes  would  ensure 
that: 

1 . Employers  would  have  to  provide 
a smoke-free  work  site  to  any 
requesting  employee. 

2.  Smoking  would  be  prohibited  in 
all  areas  of  retail  stores  accessible 
to  the  public. 

3.  Restaurants  with  seating  capacities 
of  25  or  more  persons  would  have 
to  provide  a non-smoking  area. 

4.  Smoking  would  be  prohibited  in 
all  indoor  and  outdoor  public 
places  and  sports  arenas,  as 
specifically  defined  in  the  ordi- 
nance. 


Denver  Plastic  Surgeon 
elected  to  board  of 
Doctors'  Company 

Denver  Plastic  Surgeon  David  M. 
Charles,  M.D.,  has  been  elected  to 
the  Board  of  Governors  of  The 
Doctors'  Company,  the  California- 
based  professional  liability  insurance 
company.  Dr.  Charles,  president  of 
the  medical  staff  of  St.  Joseph 
Hospital  in  Denver,  is  one  of  three 
new  members  elected  by  policy- 
holder proxies  during  the  company's 
recent  annual  meeting. 

"We  are  happy  to  be  able  to 
enhance  the  representation  on  the 
Board  of  Governors  to  include  three 
additional  highly  qualified  physi- 
cians," said  Dr.  Joseph  D.  Sabella, 
M.D.,  chairman,  president  and  chief 
executive  officer  of  The  Doctors' 
Company. 

Dr.  Charles  is  affiliated  with  the 
Plastic  Surgery  Clinic  in  Denver.  He 
serves  as  chairman  of  the  Operating 
Room  Advisory  Committee  and  is  a 
member  of  the  Medical  Executive, 
Joint  Conference,  Privileges  and 
Review,  and  Transfusion  committees 
at  St.  Joseph  Hospital  in  Denver.  He 
is  a former  president  and  a current 
member  of  the  Colorado  State 
Society  of  Plastic  and  Reconstructive 
Surgery  and  a current  member  of  the 
Denver  Medical  Society.  He  is  a 
former  member  of  Colorado  Medical 
Society.  He  serves  as  chairman  of 
the  Denver  Medical  Society  Bar 
Liaison  Committee  and  is  a member 
of  the  DMS  Patient  Liaison  and 
Internal  Affairs  committees. 


242 


Colorado  Medicine  for  July,  1993 


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House  of  Delegate 
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Make  the  investment  that 
returns  more  than  money. 


Everything  can’t  be  measured  in  cash 
flow.  Camaraderie,  Pride,  Patriotism. 
All  special  feelings  that  take  on  new 
meaning  in  the  Army  National  Guard. 
It’s  a small  investment.  But  the  returns 
are  big.  And  they’re  not  all  intangible, 
either.  The  exposure  alone  can  help 
increase  your  patient  referral  base. 

As  a physician,  you  will  be 
appointed  as  a Captain  in  the  Guard, 
with  unlimited  potential  to  further  your 
rank.  The  challenge  is  there,  too.  As 
a member  of  the  states  Trauma  Team, 
you’ll  face  medical  situations  you  don’t 
normally  see  in  your  day-to-day 
practice. 

You  can  attend  national  medical 
conventions  fully  paid  for  by  us.  We 
give  you  the  opportunity  to  expand 
your  knowledge  of  other  flelds  of 
medicine  with  Guard  sponsored 
educational  programs. 

We’ll  also  help  you  further  your 
formal  education.  The  Army  Guard 
provides  financial  assistance  for 


qualified  residency  programs,  as  well  as  outstanding 
educational  loans.  All  in  addition  to  generous  retirement 
benefits.  And  numerous  other  privileges.  If  you’re  between  the 
ages  of  21  and  47,  enrolled  or  graduate  from  an  accredited 
medical  school,  and  a U.S.  citizen,  contact  the  Army  National 
Guard  Medical  Recruiter.  2LT  JOHN  CLIFFORD 
( 303)  367-4397  or  1-800-762-4503 


Colorado  Medicine  tor  July,  1993 


243 


onfidential  medical  care 
important  to  adolescents 


This  article  has  been 
produced  at  the  request 
of  the  Committee  on 
Family  Health  and  Safety 
of  the  Council  on  Com- 
munity Health  Issues.  In 
no  way  does  it  represent 
legal  advice,  but  is  for 
general  information  only 
For  help  with  specific 
problems,  readers  should 
consult  an  attorney 


In  September,  1992,  the  Colo- 
rado Medical  Society  House  of 
Delegates  passed  RES-62-P,  empha- 
sizing the  importance  of  confidenti- 
ality in  medical  care  for  adolescents. 
As  part  of  that  resolution,  the  CMS  is 
directed  to  provide  information  to 
physicians  on  the  legal  aspects  of 
confidentiality.  Ann  Sayvetz,  Corpo- 
rate Counsel  for  Children's  Health 
Corporation,  the  parent  company  for 
The  Children's  Hospital  Association 
in  Denver,  has  written  an  article 
called  Consent  to  Treatment  and 
Access  to  Minors'  Medical  Records, 
(The  Colorado  Lawyer , Vol.  1 7,  No. 

7,  p 1 323,  1 988,  The  Colorado  Bar 
Association)  The  CMS  has  been 
granted  permission  to  reprint  it,  and 
we  will  reproduce  parts  of  it  here. 

Question 

A fifteen  year-old  minor  seeks 
and  receives  mental  health  treat- 
ment. She  is  in  the  physical  custody 
of  the  Department  of  Social  Services , 
but  her  mother's  parental  rights  have 
not  been  terminated.  The  attorney  for 
the  mother  issues  a subpoena  for  the 
daughter's  medical  records  for  the 
termination  proceeding.  Can  the 
hospital  medical  records  custodian 
release  the  records  pursuant  to 
subpoena ? Is  consent  necessary ? If 
so,  whose  - the  mother's,  daughter's 
or  Social  Services? 

Consent  to  treatment 

A person  eighteen  years  of  age 
or  older  is  considered  an  adult  in 
Colorado,  and  able  to  make  deci- 
sions regarding  medical  treatment. 
This  is  also  true  of  an  emancipated 
minor,  a lawfully  married  minor  or  a 
minor  parent  of  a minor  child. 


Minors  can  also  consent  to 
treatment  for  drug  use  or  addiction, 
alcohol  use  or  abuse,  venereal 
disease,  HIV  or  AIDS  testing,  birth 
control  including  abortion,  sexual 
assault  and  mental  health  services. 
There  are  limitations,  however.  The 
physician  may  disclose  diagnosis  of 
venereal  disease  to  a spouse,  fiance, 
parent,  legal  guardian  or  person  in 
custody  of  the  minor.  HIV  testing 
may  be  disclosed  to  parent  or  legal 
guardian  if  the  minor  is  under  sixteen 
or  not  emancipated. 

In  cases  of  sexual  assault,  the 
physician  is  required  to  make 
reasonable  efforts  to  notify  parents  or 
legal  guardians.  If  that  person  refuses 
treatment  and  the  minor  is  not  able 
to  consent  due  to  age  or  mental  or 
physical  condition,  the  physician 
may  not  treat.  However,  this  is 
reportable  as  medical  neglect  under 
child  abuse  reporting  laws.  A minor 
of  fifteen  or  older  may  also  seek 
mental  health  services,  though  an 
independent  evaluation  is  required 
to  determine  whether  admission  is 
appropriate  and  the  least  restrictive 
form  of  treatment,  before  the  minor 
may  be  admitted  to  a hospital.  Since 
minors  have  this  statutory  ability  to 
seek  treatment,  parents  probably 
may  not  limit  their  access  to  "teen 
clinics"  being  established  in  Colo- 
rado. 

Consent  not  allowed 

Minors  may  not  consent  to  organ 
transplants,  donation  of  blood, 
permanent  sterilization,  execution  of 
a living  will  for  termination  of  life 
support,  or  electroconvulsive 
treatment.  This  last,  however,  may 
be  performed  on  a minor  of  1 6 or 
older  with  approval  of  two  psychia 


244 


Colorado  Medicine  for  July,  1993 


trists  and  a parent  or  guardian. 
Because  these  statutes  are  so  specific, 
they  appear  to  block  even  emanci- 
pated minors  from  making  these 
decisions. 

Access  to  medical  records 

An  adult  patient  must  be  granted 
access  to  his  or  her  own  medical 
records  upon  written  request,  unless 
they  are  psychiatric  or  psychological 
records  which,  in  the  opinion  of  an 
independent  licensed  psychiatrist, 
"would  have  significant  negative 
psychological  impact  upon  the 
patient".  The  physician  should 
provide  a summary  of  those  records 
to  a patient  who  requests  them.  In 
general,  parents  or  legal  guardians 
must  consent  to  the  release  of  medi- 
cal records  for  minors,  until  they  turn 
1 8.  Ms.  Sayvetz  expresses  the  opinion 
that  if  a minor  has  consented  to  the 
medical  treatment,  that  minor  must 
also  consent  before  the  records  can 
be  released.  This  would  not  be  true  in 
the  case  of  a court-appointed  conser- 
vator or  guardian  seeking  mental 
health  records. 

Exceptions  to 
confidentiality 

Health  care  providers  may  give 
parents  or  guardians  summary 
information  on  mental  health  services 
given  or  needed,  diagnosis  of  vene- 
real disease,  treatment  for  positive 
HIV  test  or  AIDS,  and  treatment  for 
sexual  assault.  Other  health  care 
givers  participating  in  the  treatment  of 
the  patient  may  also  be  given  access 
to  the  records. 

Utilization  review  committees 
and  Medicaid/Medicare  Professional 
Review  Organizations  are  authorized 
to  review  medical  records,  as  is  the 


by  Michael  P.  Thompson 
Assistant  Managing  Editor 


Colorado  Department  of  Health, 
when  investigating  reports  of  AIDS, 
tuberculosis  (limited  to  pertinent 
information)  or  other  reportable 
incidents.  Physicians  may  provide 
records  to  county  Departments  of 
Social  Services  or  local  law  enforce- 
ment agencies  investigating  reports 
of  child  abuse,  to  a coroner  holding 
an  inquest  (again,  only  relevant 
information),  researchers  studying 
alcoholism  or  drug  use,  or  mental 
health  (with  identifying  information 
deleted)  and  to  state  licensing 
boards,  hospitals,  review  organiza- 
tions, professional  societies  or  their 
consultants  engaged  in  peer  review. 
Physicians  should  also  provide 
records  to  insurance  companies  or 
medical  assistance  agencies  assess- 
ing claims  for  mental  health  services, 
physicians  who  are  being  sued  by 
the  patient  in  question,  persons 
authorized  by  court  order,  agencies 
investigating  injuries  reportable  by 
law  and  the  Food  and  Drug  Adminis- 
tration in  the  investigation  of  de- 
vices. 

Litigation  and  criminal 
investigations 

Contrary  to  what  many  attorneys 
think,  says  Ms.  Sayvetz,  the  standard 
subpoena  duces  tecum  is  rarely 
adequate  to  compel  production  of 
medical  records.  The  Colorado  Rules 
of  Civil  Procedure  make  an  excep- 
tion to  subpoena  for  "privileged 
information",  which  includes 
medical  records.  Unless  the  patient 
consents  in  accordance  with  the 
above,  the  records  can  only  be 
released  under  certain  very  specific 
circumstances.  Scenario:  A patient 
sues  hospital  A and  the  physician. 


Defendants  may  release  records 
pertinent  to  their  defense.  However, 
if  patient  was  treated  at  hospital  B 
subsequent  to  the  alleged  incident, 
those  records  can  only  be  obtained 
with  the  consent  of  the  patient.  Even 
physicians  who  provided  subsequent 
treatment  may  only  be  openly 
deposed  in  a formal  discovery 
setting.  No  custodian  of  medical 
records  should  release  those  records 
to  a subpoena  duces  tecum  without 
consent  simply  because  an  attorney 
asserts  they  are  relevant  to  the  case. 
They  can  be  released  by  a physician 
or  hospital  who  is  the  target  of 
litigation  by  the  patient  who  seeks 
the  records  or  by  specific  court 
order.  Otherwise,  they  are  consid- 
ered privileged  information. 

There  are  several  instances  in 
which  a physician  may  be  required 
to  provide  medical  records.  In  the 
case  of  a grand  jury  subpoena,  a 
future  appearance  with  the  record  is 
required.  Thus  you  have  time  to 
notify  the  patient,  who  may  want  to 
appear  and  assert  medical  privilege. 
A search  warrant  signed  by  a judge 
requires  immediate  production  of  the 
records,  but  you  should  notify  the 
patient,  who  may  want  to  object  to 
their  use.  To  release  mental  health 
records,  there  must  first  be  a hearing 
at  which  you  and  the  patient  are 
allowed  to  appear.  Remember  in  all 
of  these  situations  to  release  only 
those  portions  of  the  record  pertinent 
to  the  investigation. 

Answer 

The  daughter  must  consent  to 
release  records  to  the  mother. 

Neither  the  mother's  subpoena  nor 
her  consent  is  adequate  for  proper 
release. 


Colorado  Medicine  for  July,  1993 


245 


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Publication  of  any  advertisement  in  Colorado  Medicine  is  not  an 
endorsement  by  the  Colorado  Medical  Society  of  the  product  or 
service.  Colorado  Medicine  magazine  is  the  official  journal  of  the 
Colorado  Medical  Society,  and  is  authorized  to  carry  General 
Advertising. 


♦ PROFESSIONAL  OPPORTUNITIES 

INTERNAL  MEDICINE  - Colorado  Springs: 
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1993  3/0793 

MEDICAL  DIRECTOR  - The  Attachment 
Center  at  Evergreen  has  an  appealing 
opportunity  for  a child  psychiatrist  to  serve 
as  Medical  Director  for  the  program.  The 
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This  position  offers  many  of  the  positives  of 
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This  position  pays  approximately  $4,000.00 
per  month  and  requires  approximately  one 
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Evergreen,  Colorado  is  a beautiful  mountain 
community  35  miles  southwest  of  Denver. 
Interested  candidates  should  send  resume 
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246 


Colorado  Medicine  for  July,  1993 


Classified 


TIRED  OF  THE  DAY  TO  DAY  HASSLE  of 

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call  us  and  find  out  more.  Contact  Roderic 
Gottula,  MD,  10900  Smith  Road,  Denver, 
CO  80239  or  call  (303)  375-21 1 0.6/0893 

BOULDER- AMBULATORY  CARE  CLINIC- 
Family  Medicine/Emergent  Care/ 
Occupational  Medicine  - Busy,  two 
physician  practice  seeking  full  time  BE/BC 
Family  Practitioner  to  join  growing 
comprehensive  medical  practice  in  prime 
SE  Boulder  area.  New,  well  equipped 
facility.  Minimal  call.  Flexible  scheduling. 
Send  CV  and  call  Dr.  Turnbow,  4800 
Baseline,  D-1 06,  Boulder,  Co  80303  (303) 
449-4800.  3/0593 


PHYSICIANS,  SURGICAL/ 

ANESTHESIOLOGY  RESIDENTS,  (MD/ 
DO).  Exceptional  part-time  practice. 
Colorado  and  Nationwide.  Outstanding 
fringes,  educ.  assistance.  Air  National 
Guard.  Call  Edd  (307)  772-6185.  9/0293 

UNCLE  SAM  IS  WILLING-  Would  up  to 
$50,000  a year  for  life  in  Retirement  Benefits 
- paid  in  full  in  10  years-  with  dollars  you 
are  now  paying  to  Uncle  Sam  be  of  any 
help  to  you?  We  have  the  program,  all  we 
need  is  you.  Call  H.A.  Kline  (303)  850- 
9775.  2/0593 

OCCUPATIONAL  MEDICINE-  Private 
practice,  3-4  days  per  week-  reasonable 
patient  load  - no  billing/no  hassles.  Good 
salary,  commensurate  with  experience. 
Long-term  opportu  n ity  for  partnersh  i p with 
right  person.  Call  Dr.  Shure  at  831-9393. 
3/0593 


SCOTTSDALE  INSTITUTE  for  health  & 
Medicine  invites  practitioners oftraditional 
and  alternative  medicine  to  join  us  in  our 
new  Taliesin-designed  healing  facility.  This 
sacred  adventure  will  help  define  the  new 
paradigm  for  medicine.  Immerse  yourself 
in  a special  healing  environment.  Send  CV 
to:  Andrew  Weil,  M.D.  or  Sam  Benjamin, 
M.D.  c/o  Scottsdale  Institute,  4205  Winfield 
Scott  Plaza,  Scottsdale,  AZ  85251 . 1/-793 

PE1YSICIANS — Opportunities  exist  at  this 
1 48  bed  medical  center  for  a BC/BE  Family 
Practitioner  to  work  in  our  ambulatory  care 
section  and  a BC/BE  Internist  to  provide 
inpatient  care.  Join  the  nation's  largest 
health  care  team.  Enjoy  regular  hours  (6:00 
am-4:30  pm)  weekdays  with  weekends  off. 
Must  meet  English  proficiency  requirement. 
Competitive  salary  with  excellent  benefits. 
Experience  Grand  Island,  Nebraska,  named 
one  of  the  50  best  towns  in  America  and 
three-time  recipient  of  the  All-American 
City  Award.  Contact  or  send  CV  to: 
Dormond  Metcalf,  MD,  Acting  Chief-of- 
Staff,  VA  Grand  Island,  NE  68803,  (303) 
389-5106.  EOE.  1/0793 


Donald  J.  Northey,  M.A. 

Clinical  Audiology 
Audiological  Consultants,  Inc. 

• General  Audiology 
• Hearing  aid  evaluations 
• Hearing  aid  dispensing,  service  and  aftercare 
• Amplified  stethoscopes 
• Noise,  swim  and  surgical  ear  plugs 
• Electronic  Shooters  Protection 
ENGLEWOOD  LAKEWOOD 

3575  S.  Sherman  St.,  Suite  #2  2020  Wadsworth,  #4 

761-7600  238-1366 

Providing  a rewarding  hearing  aid  experience  since  1970. 


Colorado  Medicine  for  July,  1993 


247 


RUN  A SPECIAL 
PRACTICE. 

Today’s  Air  Force  has  special  opportuni- 
ties for  qualified  physicians  and  physi- 
cian specialists.  To  pursue  medical  excel- 
lence without  the  overhead  of  a private 
practice,  talk  to  an  Air  Force  medical  pro- 
gram manager  about  the  quality  lifestyle, 
quality  benefits  and  30  days  of  vacation 
with  pay  each  year  that  are  part  of  a 
medical  career  with  the  Air  Force.  Dis- 
cover how  special  an  Air  Force  practice 
can  be.  Call 

USAF  HEALTH  PROFESSIONS 
TOLL  FREE 
1-800-423-USAF 


PHYSICIAN/  = 
CLINIC 
DIRECTOR 

Health  Network  of  Colorado  Springs, 
Inc.  has  an  opening  for  a physician  to 
assume  the  position  of  Clinic  Director 
for  an  adult  outpatient  after  hours 
operation.  The  physician  would  be 
responsible  for  medical  policy  and 
will  coordinate  the  medical  activities  of 
other  participating  physicians.  Candi- 
date should  have  current  Colorado 
license  and  be  Board-certified  or 
board-eligible  in  family  practice  or 
internal  medicine.  This  position  rep- 
resents a full-time  commitment  and 
offers  a competitive  salary  and  an 
incentive  program.  Interested  candi- 
dates should  send/fax  their  resume  to: 

Medical  Director 
Health  Network  of  Colorado 
Springs,  Inc. 

555  East  Pikes  Peak,  Suite  108 
Colorado  Springs,  CO  80903 
FAX  #719-475-5004 

EOE  E 


Your 

Whole 
Family 
Will 
Enjoy 
the 
1993 
Annual 
Meeting 

Snowmass 

C * ' 


248 


Colorado  Medicine  for  July,  1993 


♦ SITUATIONS  WANTED 

RN  Experienced  21  years  same  medical  office 
desires  challenging  medical  office  position. 
Very  flexible  S/E  Denver.  324-2927.  2/0793 

♦ PROPERTIES  FOR  SALE  OR  LEASE 

Professional  Office  Space 

Excellent  location  in  Wash  Park/DU  area. 
Share  common  pt.  waiting  room  w/  2 
internists  and  1 DDS.  Three  1 0'  X 1 0'  ops, 
reception  area.  Very  reasonable.  Call  Russ, 
688-8976.  1 2/0792 

JEWELL  & WADSWORTH-  Retail/office 
space  for  lease  - excellent  exposure  - free 
standing  building -2000  square  feet  $1 375/ 
month.  Tenant  finish  $$  available.  Call 
Billy  Halax  973-1380  6/0593 

MAUI,  HAWAII.  Luxurious  2BR/2BA, 
2,100  sq.  ft.  condominium  in  Kaanapali 
Beach  Resort,  100  yards  from  beach. 
Everything's  new!  Pool,  Jacuzzi,  Sauna, 
Lighted  Tennis  Courts,  Maids.  On  16th 
fairway  of  the  Royal  Kaanapali  Golf  Club. 
Special  Spring/Summer  Rates.  Call  985- 
9531.  6/0393 


MEDICAL  OFFICE  SPACE  ALREADY  BUILT 
OUT  AND  PAID  FOR.  Save  your  $$$$$'s. 
Greenwood  Village  location;  1-1/2  blocks 
west  of  l-25/Beileview  interchange,  very 
easy  for  patients  to  find.  3,188  rentable 
square  feet.  Extensive  medical  finishes  and 
upgrades  throughout,  x-ray  machine, 
cabinets,  desks,  phone  system,  all  available 
for  purchase.  Property  managed  on-site- 
Available  for  immediate  occupancy. 
Contact  CB  Commercial  Fairbairn/Ogilvie 
(303)  799-1800. 

♦ EQUIPMENT  FOR  SALE  OR  LEASE 

BUY  DIRECT— LOCAL  MFGR.  Custom 
Office  Furniture — Desks,  Credenzas, 
bookcases,  Files,  work  stations,  waiting 
room  seating,  etc.  Oak-cherry  & walnut. 
We  build  quality  custom  office  furniture  at 
a price  you  can  afford.  Mark  IV  Systems, 
Inc.  297-1  248.  8:00-4:30  M-F.  1 2/0293 

♦ SERVICES 

QUICK  CLAIM  ELECTRONIC  CLAIMS 
PROCESSORS,  HMO  PPO,  MEDICARE, 
MEDICAID  AND  PATIENTS  BILLING  (303) 
333-8666.  22/0393 


FOR  SALE:  Medical  Office  Building  located 
in  the  beautiful  Mtn.  community  of 
Woodland  Park,  Co.  18  Mi.  to  Colorado 
Springs  and  25  Mi.  to  Cripple  Creek.  Sale 
necessary  due  to  husband's  death.  For 
information  contact  Mrs.  R.  |.  Groeger — 
1210  W.  Lorraine  Woodland  Park,  Co.  or 
call  (719)  687-2687.  6/0293 


MEDICAL  LITERATURE  RESEARCH  — 
Want  to  review  literature  for  clinical  or 
legal  problems,  presentation  or  publication? 
Experienced  physic  ian/author/educator  will 
do  customized  multiple  database  search  at 
reasonable  rates.  Call:  Bill  Milburn,  MD  at 
823-5083;  1-800-828-9259  (outside 
Boulder/Longmont).  12/0792 


CUT  OVERHEAD 

Share  office  space  in  beautiful  modern 
building  with  agreat  view,  DTC  location, 
full  or  part  time,  ideal  for  any  specialty 
except  pediatrics.  A fully  equipped 
surgical  suite  available  on  site.  This  is  an 
excel  lent  opportu  nity  to  enjoy  a modern, 
well  equipped  facility  at  a reasonable 
cost.  Call  Lisa-773-3455  4/0793 


FOR  SALE:  2 Bedroom.  2 bath,  beachfront 
MAUI  condo,  flexible  time  share,  1 week 
even  years.  Fee  simple.  For  details  call 
(303)278-1388.  2/0593 


HOME  MORTGAGE  LOANS 
LOW  DOC  PROGRAM  available  for 
physicians  and  other  health  professionals. 
Purchase  and  refinance.  Call  Milt,  a 
mortgage  banker  with  1 8 years  experience. 
753-6262.  12/1292 

INNOVATIONS  SHOULD  BE  PATENTED 

if  marketable.  For  more  information  call 
Brian  D.  Smith  of  Fields,  Lewis,  Pittenger  & 
Rost.  Colo's  leading  patent  law  firm.  Mr. 
Smith  specializes  in  the  medical  arts.  (303) 
758-8400.  12/1192 


You  didn’t 
spend 
umpteen 
years  in 
school  in 
order  to 
become  a 

bill 

collector. 

Collecting  money  from 
slow  paying  patients  is  critical 
to  your  practice.  But  you  didn’t 
spend  all  those  years  in  school 
to  become  a bill  collector. 

And  that’s  where  I.C. 
System  can  help. 

First  of  all,  we  have  the 
resources  and  expertise  to  do 
the  job.  And  while  we’re 
tenacious,  we  treat  your 
delinquent  patients  with 
courtesy  and  respect. 

In  fact,  our  work  is  en- 
dorsed by  over  1,200  profes- 
sional associations  and  societ- 
ies, including  the  Colorado 
Medical  Society.  And  no 
matter  where  you’re  located  or 
where  your  debtors  live,  we 
have  local  representatives  to 
service  your  account. 

But  most  important,  we 
guarantee  results,  by  collect- 
ing at  least  ten  times  the 
amount  of  our  retainer. 

To  find  how  the  I.C. 

System  approach  can  work  for 
you,  call  toll  free  (800)  824- 
9469,  ext.  330. 


fftl.C  System 

The  System  J Work' 


Colorado  Medicine  for  July,  1993 


249 


Ruminations 


(def:  to  chew  again  what  has  been  chewed  slightly  and  swallowed;  to  REFLECT) 


by  Bill  Pierson,  Managing  Editor 


"When  you  get  off  the 
train  I will  shoot  you 
through  the  head  and 
after  you  fall  down  I will 
shoot  you  lengthwise 

Jesse  Hawes,  M.D. 


You  may  first  think  this  is  just 
another  beleagured  Colorado 
physician  last  week,  trying  to  keep 
the  doctor  population  down.  It  is  an 
accurate  quotation,  circa  1889 
(according  to  family  and  friends),  of 
a famous  telegram  sent  by  the  1 5th 
CMS  President  Dr.  Jesse  Hawes  of 
Greeley,  Colorado,  to  an  Alabama 
doctor  who  had  written  Hawes  of  his 
intention  to  practice  in  Greeley.  The 
Alabaman  did  not  come  to  Colo- 
rado! Actually,  there  was  more  to  the 
quotation  and  his  reasoning.  Dr. 
Hawes  closed  the  telegram  by  saying 
"I  was  your  prisoner  at  Cahaba." 

Young  Hawes,  as  a small  but 
tough  Illinois  cavalryman,  had  been 
captured  with  his  15-man  advance 
patrol  in  an  Arkansas  battle  of  the 
Civil  War.  The  Confederates  sent 
them  to  Cahaba  prison,  smaller  than 
notorious  Andersonville,  but  five 
times  as  crowded.  The  almost 
unbelievable  cruelty,  malnutrition 
and  constant  exposure  killed  hun- 
dreds in  1864-65.  Only  Hawes  and 
two  others  of  his  1 5-man  patrol 
survived  it.  His  well-written  book, 
"Cahaba;  A Story  of  Captive  Boys  in 
Blue,"  published  in  1888,  is  a factual 
and  horrifying  history,  best  read  by 
those  with  strong  stomachs. 

Dr.  Hawes  was  probably  the  first 
Colorado  doctor  to  take  a month  off 
each  winter  for  post-graduate  study. 
He  was  a hard  fighter  for  high 
principles,  and  a warm  friend  who 
helped  many  young  doctors  start 
their  practices  in  Northern  Colorado. 

After  his  Michigan  graduation  he 
earned  another  MD  from  Long  Island 
College  Hospital  in  1871,  then 
studed  in  Europe  before  settling  in 
Greeley.  He  was  for  years  a Trustee 


of  the  State  Normal  School  (now 
University  of  Northern  Colorado), 
taught  obstetrics  at  the  old  Denver 
Medical  College,  served  on 
Colorado's  first  Board  of  Medical 
Examiners,  and  was  the  1893-94 
Vice  President  of  the  AMA. 

One  evening  a rancher  asked  Dr. 
Hawes  if  it  was  really  worth  $3  to 
have  his  daughter  vaccinated  — one 
of  her  schoolmates  had  smallpox. 
"Well,  let's  see,"  Dr.  Hawes  ex- 
plained, "You're  1 1 miles  from  town. 
If  your  daughter  takes  smallpox  I'll 
charge  you  $ 1 5 for  each  house  call, 
probably  for  two  weeks.  Meanwhile, 
your  other  children  will  probably 
take  it,  and  if  I have  any  luck  it  will 
run  on  for  six  weeks.  ..."  The 
rancher  jammed  on  his  hat  and  said 
"I'll  bring  'em  all  in  at  9 in  the 
morning."  Dr.  Hawes  knew  how  to 
persuade,  friendly  or  otherwise. 


Jesse  Hawes 

August  21,1  843  — August  4,  1 901 
MD  1868,  University  of  Michigan. 
1 5th  President  of  CMS  (1  884-85). 


Excerpts  from  Rocky  Mountain  Medical 
journal,  Colorado  Edition,  Colorado  Medical 
Society  Celebrates  100  Years  1871  - 1971  Vol. 
68,  Number  4,  April,  1971 


250 


Colorado  Medicine  for  July,  1993 


C 


STACKS 


M 


°£D  SEP^  X' 


"Advocating  excellence  in  the  profession  of  medicine" 

HIALTH  SCIENCES  LIBRARY 

UNIVLRSt  TY  -OF  MARYLANQ 


igust,  1993 


BALTIMORE 


AUG  111993 


EEC.U 


Annual  Meeting 
of  the 

KOI  |N  t^MS  House  of  Delegates 
Snowmass  Conference  Center 
Snowmass  Village,  Colorado 
September  9 through  12,  1993 


e Out  There!" 


STACKS 


Vermont  Governor  Howard  Dean,  M.D., 
keynote  speaker  at  the  CMS  1 993  Annual 
Meeting 

Something  for  Everyone! 

Bring  the  entire  family 
One  of  our  most  popular  meeting  sites. 


Volume  90,  Number  8 


Fishing...  it  couldn't  be  better! 


Beautiful  Snowmass 
with  lots  to  do 


Golfing  ...  The  Snowmass  Club! 


Walking,  Biking,  Hiking  ... 
this  is  the  place! 


i This  Issue: 

Re-Engineering  Health  Care,  by  Leigh  Truitt,  MD Page  257 

Hurricane  in  Paradise  by  James  Pagle,  MD Page  262 

On  the  road  to  the  Annual  Meeting See  Page  253  and  following 

CPR  DNR  Forms — Have  You  Ordered  Yours  Yet? Page  280 

Corrections  and  Reflections See  Ruminations,  Page  286 


Can  you  imagine  a physician  who  would  run  a classified  advertisement  like  that? 

♦♦♦  Of  course  not.  And  yet,  some  Colorado  physicians  choose  their  malpractice 
insurance  carrier  that  way  Unfortunately,  when  they  sort  through  the  fine  print 
of  their  policy  they  often  discover  that  Brand  X wasn’t  even  the  low  bidder,  let 
alone  the  most  competent  to  avoid  or  defend  malpractice  suits,  or  to  provide 
vital  services  to  policyholders  and  the  Colorado  physician  community.  ♦♦♦  By 
all  means,  comparison  shop  if  you’re  in  the  market  for  malpractice  insurance. 
But  when  you  do,  be  certain  that  you  make  your  choice  based  on  all  the  facts 
and  figures.  ♦♦♦  We  are  confident  that  you  will  choose  Copic.  More  often  than 
not,  we  will  be  the  low  bidder,  once  you  reach  the  real  bottom  line. 

The  Copic  Bottom  Line. 

It’s  more  than  just  competitive  rates. 


Opic 


Copic  Insurance  Company 

PO.  Box  17540  • Denver,  CO  80217-0540  • (303)  779-0044  • 1-800-421-1834 


Cover  Story 


Colorado  Medicine 

August,  1993  Volume  90,  Number  8 


In  This  Issue... 

Leigh  Truitt,  MD,  President 
Colorado  Medical  Society 


262  Hurricane  in  Paradise 


James  Pagle,  MD 


Every  member  of  the  family 
will  find  something  to  enjoy 
at  the  1 993  Annual  Meeting 
in  Snowmass,  September  9- 
1 2.  It's  not  all  business. 


Departments 


265  Special  Section: 

1993  Annual  Meeting 

273  Health  System  Reform  Committee  Debates  Top  Issues 

Robert  M.  Bogin,  MD 
Jo  Parkin 

276  Understanding  Health  Care  Integration — Part  1 

Ted  Lewis,  M.D.,  Director  of  Medical  Education 
Penrose-St.  Francis  Hospital,  Colorado  Springs,  Colorado 

282  Hall  of  Life  Fact  Sheet 


257 President's  Letter 
260 Executive  Director's  Update 
273  Health  System  Reform 
275  Health  Care  Policy 
277Cormponent  Society  News 
278Medical  News 
279 Health  Department 
283  Board  Highlights 
284Classified  Advertising 
286Ruminations 


Colorado  Medical  Society 


COLORADO  MEDICAL  SOCIETY 
OFFICERS,  BOARD  MEMBERS  and  AMA  DELEGATES 


1992/1993  Officers 
Leigh  Truitt,  M.D. 

President 

Wm.  Carl  Bailey,  MD 

President-elect 
Terrance  J.  Sullivan,  M.D. 

Treasurer 

Stuart  O.  Silverberg,  M.D. 

Speaker  of  the  House 

David  C.  Martz,  M.D. 

Vice-speaker  of  the  House 

Sandra  L.  Maloney 

Secretary/Executive  Director 

Harrison  G.  Butler,  III,  M.D. 

(Immediate  Past  President) 


Board  of  Directors 

Board  of  Directors 

Thomas  J.  Allen,  MD 

Susan  A.  Sherman,  MD 

Stephen  G.  Batuello,  MD 

Denis  J.  Winder,  MD 

John  O.  Cletcher,  Jr.,  MD 

M.  Robert  Yakely,  MD 

Donald  G.  Eckhoff,  MD 

John  E.  Ell  iff,  MD 

AMA  Delegates 

Jonathan  C.  Feeney,  MD 

David  C.  S.  Franklin,  MD 

M.  Ray  Painter,  Jr.,  MD 

Joel  M.  Karlin,  MD 

Richert  E.  Quinn,  Jr.,  MD 

George  M.  Kreye,  MD 

Mark  A.  Levine,  MD 

Muryl  L.  Laman,  MD 

Ted  T.  Lewis,  MD 

Alternate  Delegates 

Theresa  A.  Scholz 

Louise  L.  McDonald,  MD 

Robert  D.  McCartney,  MD  ! 

Robert  A.  Nathan,  MD 

Robert  M.  Bogin,  MD 

Kenneth  M.  Olds,  MD 

Joel  M.  Karlin,  MD 

Lothar  K.  Roller,  MD 

David  Shander,  MD 

Robert  R.  Montgomery, 

W.  George  Shanks,  MD 

Legal  Counsel 

COLORADO  MEDICAL  SOCIETY  STAFF 


Executive  Office 

Sandra  L.  Maloney,  Executive  Director 
Mary  Lee  Johnston,  Executive  Admin.  Asst. 
Nancy  L.  Deter,  Manager,  Accounting 

Western  Slope  Office 

Dolores  M.  Bennett,  Executive  Secretary 

Division  of  Membership  Information  Services 

Timothy  H.  Roberts,  Director 
Diane  L.  LeHew,  Manager,  Support  Services 
Debra  M.  Jones,  Membership  Coordinator 
Beth  M.  Crusha,  Administrative  Assistant 


Division  of  Health  Care  Policy 

Ellen  J.  Stein,  Director 

Marilyn  P.  Barton,  Program  Manager 

Lynn  R.  Livingston,  Administrative  Assistant 

Division  of  Health  Care  Financing 

Edie  K.  Register,  Director 
Marijo  M.  Parkin,  Program  Manager 

Division  of  Government  Relations 

Sue  Ellen  Quam,  Director 

Lorraine  L.  Koehn,  Program  Manager/Lobbyist 

K.  Suzanne  Hamilton,  Administrative  Assistant 


Division  of  Professional  Services 

Sandra  M.  Finney,  Director 
Lorraine  K.  Heth,  Program  Manager 
Kirsten  E.  Regalado,  Secretary 


Division  of  Communications 

William  S.  Pierson,  Director 

Michael  P.  Thompson,  Communications  Mgr. 

Gil  Maestas  II,  Communications  Specialist 


COLORADO  MEDICINE  (ISSN-01 99-7343)  is  published  monthly  as  the  official  journal  of  the  Colorado  Medical  Society,  7800  E.  Dorado  PI.,  Englewood,  CO  801 1 1 . Telephone  (303)  779-5455.  Outside 
Denver  area,  call  1-800-654-5653.  Secona  Class  postage  paid  at  Englewood,  Colorado,  and  at  additional  mailing  offices.  POSTMASTER,  send  address  changes  to  COLORADO  MEDICINE,  P.  O.  BOX 
1 7550,  Denver,  CO  80217-0550.  Address  all  correspondence  relating  to  subscriptions,  advertising  or  address  changes,  manuscripts,  organizational  and  other  news  items  regarding  the  editorial  content 
to  the  editorial  and  business  office.  Subscriptions  are  available  for  $30  per  year,  paid  in  advance. 

COLORADO  MEDICINE  magazine  is  the  official  journal  of  the  Colorado  Medical  Society,  but  as  such  is  also  authorized  to  carry  general  advertising.  Publication  of  any  advertisement  in  COLORADO 
MEDICINE  does  not  imply  an  endorsement  or  sponsorship  by  the  Colorado  Medical  Society  of  the  product  or  service  advertised.  Published  articles  represent  opinions  of  the  authors  and  do  not  necessarily 
reflect  the  official  policy  of  the  Colorado  Medical  Society  unless  clearly  specified. 

Sandra  L.  Maloney,  Executive  Editor;  William  S.  Pierson,  Managing  Editor;  Michael  Thompson,  Asst.  Managing  Editor,  Gil  Maestas,  II,  Communications  Specialist 


Member,  Colorado  Press  Association, 


Member,  Colorado  Broadcasters  Association 


256 


Colorado  Medicine  for  August,  1993 


Photo  by  Rocky  Mountain  News 


Leigh  Truitt,  MD 
President,  1992-1993 


President's 


L 


Re-Engineering  Health  Care 


Michael  Hammer,  an  American 
management  consultant,  popularized 
the  concept  of  "business  process  re- 
engineering" in  1990.  This  has  been 
described  as  reinventing  a business 
from  scratch  in  order  to  increase 
productivity  and  competitiveness. 

To  anyone  not  running  a com- 
pany, the  fuss  among  business- 
men about  re-engineeering  — or 
"process  redesign"  as  it  is  also 
called  — seems  puzzling.  Its  two 
basic  ideas  sound  obvious,  and 
neither  is  new.  The  first  is  to  start 
with  a clean  sheet  of  paper  and 
design  all  or  parts  of  the  opera- 
tions of  a company  in  the  best  way 
possible.  The  second  is  to  look  on 
companies  as  performing  a small 
number  of  continuing  processes, 
rather  than  as  collections  of  dis- 
tinct, though  related,  functions. 
Are  not  managers  constantly  ex- 
horted to  adopt  a fresh  approach 
to  their  jobs  and  to  "streamline" 
their  businesses?  And  is  the  differ- 
ence between  a "process"  and  a 
"function"  anything  more  than  a 
semantic  quibble? 

The  answer  to  both  questions  is 
yes,  says  Mr.  Hammer.  He  cheer- 
fully admits  that  there  is  nothing 
new  about  re-engineering.  "These 
ideas  are  obvious.  No  one  dis- 
putes them.  The  trouble  is,  until 
recently  no  one  followed  them 
either."  Managers  often  talk  about 
fundamental  re-examination  of 
their  business,  but  most  of  the 
improvement  they  attempt  is  in- 
cremental. Question  i ng  everyth  i ng 
a company  does  is  usually  too 
risky  and  confronts  too  many  en- 


trenched interests  among  manag- 
ers and  employees  to  be  worth 
doing  unless  a firm  is  in  dire 
trouble.  By  then  a complete  over- 
haul is  often  too  late  to  be  of  much 
use.1 

Should  we  attempt  to  re-engi- 
neer health  care?  We  certainly  want 
to  increase  productivity  and  cost- 
effectiveness.  Is  health  care  similar 
enough  to  other  businesses  to  benefit 
from  this  process?  Are  we  prepared 
to  take  the  steps  necessary  to  rein- 
vent our  health  care  system? 

I will  try  to  convince  you  that  we 
are  already  re-engineering  health 
care  - - that  we  are  redesigning  the 
processes  of  patient  care  in  the 
interests  of  productivity  and  cost 
efficiency.  You  must  decide  for 
yourself  the  question  of  how  this 
affects  quality  of  care. 

Productivity  is  defined  simply  as 
inputs  divided  by  outputs,  i.e.,  the 
total  input  of  resources  required  per 
unit  of  output.  Quality  is  a very 
important  measurement  of  output 
since  reject  and  rework  rates  are 
major  influences  on  the  amount  of 
output.  Total  factor  "productivity 
improvement  comes  from  cutting 
costs  of  labor,  materials,  and  other 
resource  inputs  - - and  raising 
outputs."  2 This  means  that  there  are 
only  three  ways  of  raising  productiv- 
ity: 

• Using  fewer  resources  per  unit 
of  output,  i.e.,  office  visit  or 
procedure. 

• Using  cheaper  resources  per 
unit  of  output. 

• Using  no  resources,  i.e.,  not 
doing  something  at  all. 


"Are  we  prepared  to  take 
the  steps  necessary  to 
reinvent  our  health  care 
system?" 


Continued  on  following  page... 


Colorado  Medicine  for  August,  1993 


257 


resident's 


Letter 


"Unfortunately,  we  have 
very  little  understanding 
of  the  process  of  health 
care  . . . " 


For  the  hospital  industry  in 
1991,  payroll  and  employee  benefit 
costs  comprised  54%  of  total 
expenses.  Unfortunately,  hospital 
productivity  is  decreasing  rather  than 
increasing. 

In  1982,  hospitals  employed 
353  FTEs  per  100  adjusted 
patient  census.  By  1991,  that 
figure  jumped  22%  to  431  per 
100  adjusted  patient  census, 

AF1A  figures  reveal.3 

I feel  sure  that  in  our  offices  a 
similar  percentage  of  costs  are 
devoted  to  labor,  especially  if  we 
include  ourselves.  As  you  well 
know,  in  both  the  inpatient  and 
outpatient  spheres,  we  are  not  doing 
less  per  unit  of  service  - - we  are 
doing  more.  More  documentation, 
more  utilization  review,  more 
quality  assurance.  This  requires 
more  personnel  and  their  supporting 
resources. 

Perhaps  if  we  could  use  cheaper 
personnel  to  do  the  same  tasks,  we 
could  increase  productivity. 

The  ANA  sounded  the  alarm  in 
a May  1 4 press  release  head- 
lined "American  Nurses  Associa- 
tion concerned  at  growing  RN 
layoffs".  The  ANA  said  many 
hospitals  across  the  country  are 
laying  off  registered  nurses  or  not 
filling  vacant  positions.  Many  of 
the  same  hospitals  are  hiring 
unlicensed  and  less  expensive 
personnel  to  pick  up  the  slack, 
the  ANA  said.4 


continued... 


Lest  we  be  complacent  about 
this  possibility,  we  need  to  recog- 
nize that  specialists  may  be  replaced 
by  primary  care  physicians,  and 
primary  care  physicians  may  be 
replaced  by  nurse  practitioners  and 
physician  assistants. 

The  third  alternative,  not  using 
resources  at  all,  is  also  possible.  The 
change  from  fee-for-service  to 
capitation  will  result  in  incentives  to 
do  fewer  hospitalizations,  less 
imaging,  fewer  procedures.  Our 
concerns  will  be  directed  to  assuring 
that  we  did  enough  rather  than  too 
much.  Some  of  this  may  be  substitu- 
tion of  an  inexpensive  office  visit  for 
an  expensive  diagnostic  test  or 
treatment  over  the  telephone  for  an 
office  visit. 

Unfortunately,  we  have  very 
little  understanding  of  the  process  of 
health  care  - - of  the  determinants  of 
high  quality  and  good  outcomes. 
When  we  try  to  re-engineer  our 
care,  we  must  guard  against  looking 
at  the  entire  process  rather  than 
concentrating  on  each  of  our 
individual  functions.  We  may  be 
able  to  improve  both  the  quality  and 
efficiency  of  health  care. 


’ Take  a clean  sheet  of  paper.  Behind  the 
hype  surrounding  "business  process  re- 
engineering" lurks  an  important  message 
to  companies."  The  Economist,  p.  67-68, 
May  1,  1993. 

2 Richard  j.  Schonberger,  Operations 
Management:  Productivity  and  Quality,  p. 
509,  1985. 

3 David  Burda,  "Hospitals  cut  labor  force  in 
anticipation  of  reform,"  Modern  Health- 
careL  p.  27,  June  21,1 993. 

4 Ibid. 


258 


Colorado  Medicine  for  August,  1993 


Computer  Talk 

Medical  Practice  Automation  Issues  & Information 

a service  of 

/MicroAge 

8620  Wolff  Court  - Westminster,  CO  80030  (303)  427-2121 


Increasing  User  Productivity: 

The  Forgotten  Promise  of  Office  Automation 


Selecting  a computer  vendor 
for  a medical  practice  can  be  a 
difficult  and  often  confusing  process. 
After  surviving  several  information- 
packed  sales  presentations,  even  the 
most  competant  prospective  buyers 
may  have  difficulty  differentiating 
one  solution  from  another. 

If  a computer  vendor  has  a 
healthy  track  record  and  offers  a 
powerful,  feature-rich  package,  they 
stand  every  chance  of  ending  up  as  a 
finalist.  But  today  there  are  several 
vendors  who  meet  these  criteria,  so 
that  after  the  initial  selection  process 
is  done,  you  may  still  find  yourself 
looking  at  several  promising  systems. 

In  this  frustrating  search  for 
the  best  of  all  possible  solutions,  it  is 
easy  to  lose  sight  of  the  primary 
reason  for  buying  a computer  in  the 
first  place:  the  promise  of  increasing 
the  productivity  of  your  office  staff. 

It  doesn't  matter  how  many 
features  a system  has  if  those  features 
aren't  extremely  easy  to  use  ("If  it's 
not  easy  to  use,  it's  easy  not  to  use 
it").  And  if  all  the  systems  list 
essentially  the  same  functions,  you 
may  be  tempted  to  select  the  least 
expensive  one.  But  of  what  real  value 
is  an  "inexpensive"  system  that  in 
reality  creates  as  much  effort  as  it 
saves? 

Recently,  user  productivity  is 
making  a kind  of  comeback  as  a key 
differentiater  in  the  computer  selec- 
tion process.  This  trend  promises  to 
continue  under  health-care  reform,  as 
practices  are  required  to  streamline 
their  operations.  In  two  1992  cases 
outside  the  health-care  industry. 


federal  contract  appeals  boards 
backed  the  most  costly  of  several 
computer  bids  to  the  IRS  and  the 
Navy,  on  grounds  that  the 
"expensive"  solution  promised  the 
most  significant  positive  impact  on 
user  productivity.  In  the  IRS 
instance,  the  winning  vendor,  AT&T, 
submitted  a bid  nearly  50%  higher 
than  competitor  IBM,  and  34%  higher 
than  one  from  a competing  Lockheed 
Corporation  subsidiary.  In  the  end, 
the  system  that  was  considered  to  be 
the  most  cost-effective  was  the  one 
that,  despite  its  higher  cost,  actually 
increased  its  users  ability  to  do  work  . 

Your  office  is  no  exception 
to  this  rule.  Your  employees'  time  is 
literally  money.  Your  money. 

How  can  you  tell  which 
prospective  computer  system  will 
deliver  the  greatest  increase  in  the 
productivity  of  your  staff?  Unfor- 
tunately, relying  on  vendor  references 
is  really  not  much  help.  Users  experi- 
encing a 30%  increase  in  productiv- 
ity on  Brand  X are  as  likely  to  sing  its 
praises  as  are  those  enjoying  an  80% 
increase  on  Brand  Y. 

You  can  identify  some  key 
labor-saving  differences  between 
systems  by  asking  some  important 
questions  during  product  demon- 
strations, or  when  visiting  with 
practices  who  are  using  the  proposed 
systems.  How  many  keystrokes  do 
the  most  commonly  used  functions 
take?  How  many  screen  changes? 

It  may  not  seem  important  at  first 
glance,  but  a few  seconds  here,  and  a 
few  minutes  there;  it  all  adds  up.  And 
you  pay  for  that  time  in  salary  dollars. 


Can  users  move  from  one 
screen  to  another  and  then  back 
again  without  losing  track  of  where 
they  are?  How  easily?  More 
productivity  is  lost  lumbering  back 
and  forth  between  menus  than  ever 
was  lost  to  sick  time. 

If  the  system  does  not  have 
true  multi-tasking  capabilities  (e.g. 
running  insurance  claims  in  the 
background  while  users  work  in  other 
areas  of  the  system,  such  as  found  in 
UNIX  systems),  don't  consider  it. 

You  will  be  paying  users  to  watch 
"Please  Wait"  messages. 

Does  the  system  take 
advantage  of  laser  printing  technol- 
ogy? The  ability  to  produce  paper 
forms  on  plain  paper  can  go  a long 
way  toward  eliminating  the  printer 
bottlenecks  that  strangle  productivity. 

What  things  will  the  system 
do  for  you  that  you  would  otherwise 
have  to  do  yourself?  One  sure  way 
to  turn  productivity  increases  into 
measurable  dollar  savings  is  through 
the  use  of  automatic  follow  up  letters, 
such  as  insurance  claim  tracers  and 
appeal  letters.  (Watch  out  here.  If 
you  have  to  create  these  letters  one  at 
a time  yourself,  even  using  the 
computer,  you're  not  getting  your 
money's  worth). 

Many  systems  available 
today  boast  impressive  laundry  lists 
of  bells  and  whistles.  But  the  system 
you  ultimately  select  should  be  the 
one  that  promises  to  deliver  the  best 
increase  in  your  office  productivity. 

After  all,  that's  what  a 
computer  is  supposed  to  do. 

Remember? 


X EC  U T I V E 


Director's 


Update 


"...  such  reorganization 
can  only  be  done  if  a 
majority  of  membership 
heed  the  President's 
appeals  and  direction ." 


The  President-elect's  Planning 
Conference  was  held  in  Fort  Collins 
on  July  1 7-1 8,  with  the  idea  in  mind 
that  CMS  leadership  should  know 
where  the  membership  wants  to  go 
during  the  coming  year  before 
getting  behind  the  wheel  to  steer  the 
organization. 

What  actually  came  out  of  that 
conference  was  the  idea  that  the 
leadership  had  better  be  pretty  clever 
because  the  Society  is  going  to  have 
to  change  its  course  or  direction  at 
any  given  moment.  The  participants 
decided  that  health  care  (or  system) 
reform  will  demand  that  CMS  be 
adaptable  and  capable  of  changing 
direction  based  on  the  demands  of 
reform.  Well,  if  the  (doctor)  leader- 
ship has  to  be  handy,  think  what  the 
staff  has  to  be.  Now  isn't  that  a great 
challenge? 

I am  not  all  concerned  about 
getting  the  job  done;  we  can  do  it.  I 
am  concerned  about  what  our 
general  membership  will  think  of 
their  organization  when  it  seems  to 
have  no  positive  direction,  destina- 
tion or  goal. 

CMS  has  always  worked  to  adapt 
to  the  day-to-day  needs  of  the 
physician  member.  This  was  the 
new  approach  when  malpractice 
insurance  was  our  major  problem 
back  in  the  late  1970s.  The  Society 
was  reorganized  to  meet  the  needs  of 
the  day.  Its  Board  of  Trustees 
became  a Board  of  Directors  to 
allow  the  Board  to  operate  the 
society  on  a day-to-day  basis,  with 
major  policy  being  the  responsibility 
of  the  House  of  Delegates. 

We  did  it  again  in  the  early 
1980s  when  the  Society  moved  from 
the  Executive  Vice  President  of  CMS/ 


CFMC  (Colorado  Foundation  for 
Medical  Care),  thereby  severing  the 
connection  between  the  two  organi- 
zations. We  had  to  because  we 
needed  an  arm's  length  relationship 
in  the  face  of  creating  a doctor- 
owned  insurance  company,  building 
a building,  and  responding  to  the 
threat  of  the  new  DRGs  (diagnosis 
related  groups)  and  peer  review. 
Also,  there  was  the  reality  of  the 
Foundation  being  forced  out  of  the 
federal  PSRO  (peer  review  organiza- 
tion) role  and  becoming  a private 
contractor. 

And  again,  in  the  mid-1980s 
when  CMS  took  a position  against 
the  no-pay/slow-pay  of  the  state 
Medicaid  intermediary,  the  Society 
saw  the  need  for  physician  advocacy 
in  dealing  with  third-party  payers. 
CMS  even  filed  suit  and  won.  That 
victory  in  court  also  saw  the  end  of 
the  out-of-state  intermediary  and  an 
assurance  of  a much  better  provider- 
payer  relationship  which  has  lasted 
for  nearly  seven  years  now. 

One  of  the  things  CMS  has  not 
done  well  over  these  years  is  to  say 
"Enough,  already!"  when  it  is 
obvious  the  organization  is  becom- 
ing a supermarket,  trying  to  be  all 
things  to  all  people.  What  has 
happened  is  as  a need  arises,  a 
committee  is  created,  a study  is 
made,  and  a program  or  adjunct 
position  is  added  onto  the  CMS  core 
structure.  As  a result,  CMS  has 
become  top-heavy  with  appurte- 
nances of  all  size  and  nature,  many 
of  which  overlap  efforts  of  other 
organizations,  committees,  etc.,  and 
just  hang  around  until  the  next  big 
move  to  sunset. 

What  CMS  needs  to  become 


260 


Colorado  Medicine  for  August,  1993 


Sandra  L.  Maloney 
Executive  Director 
Colorado  Medical  Society 


today  is  lean,  mean,  ready  to  re- 
spond to  brush  fires,  containment,  or 
minor  skirmishes  along  the  front 
lines  of  the  reform  movement.  Our 
position  becomes  more  and  more 
like  a two-theater  military  operation: 
1)  state  health  planning  and  2) 
Clinton  Administration  plans.  We 
must  be  ready  to  respond  to  either 
one  or  both  at  the  same  time,  as  well 
as  continue  the  necessary  core 
operations  of  the  organization,  i.e., 
membership,  professional  education, 
communications,  information, 
member  services,  etc. 

1 can  say,  truthfully,  that  such 
reorganization  can  only  be  done  if  a 
majority  of  membership  heed  the 
President's  appeals  and  direction.  In 
this  case,  Doctor  Bill  Bailey  has  a 
huge  job  on  his  hands,  but  he  is 
meeting  the  challenge.  He's  pulled 
up  his  knickers  and  wading  into  the 
fray  like  Douglas  MacArthur  came 
ashore  on  his  return  to  Bataan!  He 
needs  the  troops  behind  him  though. 
Neither  he  nor  staff  can  do  it  alone. 

The  Executive  Committee  is  busy 
preparing  a concept  paper  for 
consideration  at  the  Annual  Meeting 
in  September.  Give  me  a call  if  you 
want  the  details. 


Please  take  note  of  the  address  change 
for  The  Colorado  Physician  Health 
Program.  Our  new  offices  are  now 
accessible  to  physicians  with  mobil- 
ity impairments. 

CPHP  serves  the  needs  of  the  Colo- 
rado medical  community  through 
problem  identification,  treatment  re- 
ferral, monitoring,  clinical  consulta- 
tion and  support  to  individuals  and 
their  families. 

Physicians  who  may  be  experienc- 
ing physical,  emotional,  or  psycho- 
logical problems  may  elect  to  refer 
themselves  for  evaluation.  Family 
members,  colleagues,  or  other  con- 
cerned individuals  may  also  provide 
a referral  for  a physician  in  need  of 
assistance. 

The  Colorado  Physician  Health  pro- 
gram is  a non-profit  organization  es- 
tablished by  the  Denver  and  Colorado 
Medical  Societies.  These  physicians 
recognized  that  organized  medicine 
had  an  important  role  in  physician 
health:  identifying  and  rehabilitating 
physically  or  emotionally  distressed 
and  impaired  physicians. 


TRUE  OR  FALSE? 

1.  Was  practice  income  higher  for  most  Colorado  physicians  in  1992  than 
in  1988? 

2.  Was  personal  income  higher  for  most  Colorado  physicians  in  1992  than 
in  1988? 

3.  Was  practice  income  higher  in  1992  and  personal  income  higher  in  1988 
for  most  Colorado  physicians? 

If  you  answered  True  to  1 and  2 and  False  for  3,  you  may  be  in  for  quite  a 
surprise.  We  believe  the  typical  financial  scenario  for  most  Colorado 
physicians  is  best  expressed  by  a True  answer  to  question  3. 

What  IS  true  about  your  practice  and  personal  income  when  you  compare 
1992  and  1988  bottom  lines?  Do  you  know  why  you  achieved  those 
particular  results?  Do  you  know  what  you  must  do  to  improve  your  future 
financial  position? 

We  would  like  to  help  all  Colorado  physicians  better  understand  the 
financial  dynamics  of  their  medical  practices  and  how  their  practices 
compare  to  others  in  this  Colorado  by  medical  specialty  and  geographic 
area.  Both  our  services  and  our  survey  are  conducted  in  a completely 
confidential  manner.  We  urge  you  to  participate  in  this  important  program. 
Get  the  facts!  Please  mail  the  coupon  or  call  303-290-9191  to  receive  a 
$75.00  discount  on  your  CONFIDENTIAL  PRACTICE  PROFILE. 

INTRODUCTORY  OFFER  - SAVE  $75.00! 

Yes,  I am  concerned  about  my  financial  situation  and  would  like 
to  know  how  to  enhance  my  practice  and  personal  income. 

Name 

Specialty 

Address 

City  State Zip  Code 

Telephone Best  time  to  call  

MAIL  TO:  DAVID  SCHORE  & PARTNERS 

8200  South  Quebec  Street.  Suite  A-290.  Englewood.  CO  80112 


Colorado  Medicine  for  August,  1993 


261 


Hurricane  Iniki,  island  of  Kuaui,  September,  1992 


Hurricane  i 


Paradise 

September  of  last  year  was  put 
aside  as  vacation  time  to  study  for 
my  sleep  medicine  boards.  I was 
planning  to  return  to  the  island  of 
Kauai  where  I had  worked  for  seven 
years  after  completing  my  family 
practice  residency  in  Grand  Junction. 
But  plans  change.  On  September  1 1 
Hurricane  Iniki  suddenly  turned 
north  and  attacked  Kauai  with  its 
1 60  mile-per-hour  winds.  After  the 
storm  there  was  an  uneasy  silence 
from  family  and  friends  on  the 
island,  confounded  by  a smattering 
of  news  photos  depicting  the  de- 
struction of  places  we  had  known 
well. 

That  silence  was  finally  broken 


in  the  unusual  fashion  of  a letter 
from  a nursing  friend  brought  to 
Honolulu  by  an  evacuated  fisher- 
man, the  only  survivor  of  his  boat, 
who  had  endured  the  storm  floating 
the  giant  waves  in  his  styrofoam  fish 
box.  Fifteen  years  of  medical 
practice  tends  to  exhaust  the  altruis- 
tic impulse,  but  this  disaster  had 
affected  adopted  families,  long-term 
patients  and  friends.  Disaster  relief 
organizations  primly  informed  me 
that  I was  not  needed,  but  tenuous 
contacts  from  the  island  said  other- 
wise. I unpacked  my  golf  clubs, 
stocked  up  all  samples  of  antibiotics 
and  packed  my  tent,  arriving  on 
Kauai  five  days  after  the  storm. 

I arrived  at  the  Lihue  airport  in 
an  almost  empty  plane  unsettled  by 
the  surrounding  destruction.  De- 
jected people  huddled  holding  their 


262 


Colorado  Medicine  for  August,  1993 


James  Pagle,  M.D. 
Pueblo,  Colorado 


heads  in  their  hands.  The  sugar  mill's 
broken  smokestack  bit  into  the 
sunset  like  a jagged  tooth  as  I drove 
a rental  car  west  down  eerie,  unlit 
roads  draped  with  snaking  electrical 
lines  that  sang  when  crossed  by  my 
tires.  I worked  my  way  past  piles  of 
rubble  into  Waimea  Valley  where  I 
had  built  a house.  Beyond  expecta- 
tions it  was  one  of  the  few  houses 
still  standing,  sheltering  homeless 
friends  camping  out  in  the  carport 
until  matters  improved. 

At  the  hospital,  the  staff  was  ex- 
hausted. Physicians  and  support 
personnel  were  living  at  the  hospital, 
or  like  my  former  partner,  in  the  few 
undamaged  rooms  at  Waimea's  only 
hotel.  He  showed  me  his  house,  its 
walls  disrupted  by  the  ocean  and  its 
roof  by  the  winds.  Like  almost  a 
third  of  the  houses  on  the  island,  his 
house  was  totally  destroyed.  Perhaps 
another  third  were  like  mine, 
suffering  major  structural  damage 
when  hit  by  two  flying  roofs.  In  my 
first  three  days  there,  I helped  roof 
three  houses,  pounding  salvaged  tin 
and  plastic  into  place  over  broken 
rafters. 

At  the  hospital,  I was  tacked  into 
the  ER  schedule,  working  fifteen 
hours  a day,  patching  primarily 
people  injured  in  trying  to  fix  up 
their  houses  or  sick  from  drinking 
contaminated  water.  I saw  my  former 
patients  decompensate  from  illnesses 
that  had  been  under  control  before 
the  storm.  An  initial  euphoria  of 
survival  was  being  replaced  by  a 
pervading  depression  in  which  no 
one  wanted  even  to  think  of  what  the 
future  might  hold. 

In  my  two  weeks  there,  some 
things  slowly  returned  to  normal, 


with  each  town  having  clean  water, 
a phone  bank,  and  generators  at  the 
grocery  stores.  It  was  amazing  how 
quickly  people  grew  used  to  cold 
showers  and  the  whine  of  generators 
each  night.  At  the  ER,  volunteer 
residents  from  Queen's  Medical 
Center  in  Honolulu  returned  home, 
and  army  physicians  returned  to  their 
routines,  though  still  available  for 
emergency  trips  off-island.  Friends 
cleared  away  debris  from  patches  of 
yard  in  front  of  their  picture  windows 
so  they  could  sit  inside  and  look  out, 
pretending  that  all  was  still  normal. 
Working  as  a physician,  there  was 
no  money  and  no  rest  in  helping  in 
this  disaster,  but  there  was  the 
satisfaction  of  having  a skill  that  even 
in  the  face  of  catastrophe  was  useful 
for  helping  others. 


I returned  recently,  almost  a year 
after  the  storm.  Kauai  is  still  beauti- 
ful, although  much  has  changed. 

The  amazing  beaches  are  still 
beautiful,  and  trails  into  the  rain 
forest  are  at  least  partially  open  once 
again.  Working  the  disaster  changed 
me,  and  when  I see  Kauai  now,  I see 
the  faces  that  experienced  the  winds 
of  Iniki.  On  the  mountains  of  Kokee, 
an  endless  cloud  of  rain  falls  steadily 
on  the  broken  trees  where  the 
tropical  flowers  bloom.  Hopefully 
those  same  flowers  will  grow  into 
great  trees  before  the  next  such 
storm. 


Article  and  photos  by  Dr.  Pagle  who  resides  in 
Pueblo,  CO.  and  specializes  in  Family  Practice. 


Colorado  Medicine  tor  August,  1993 


263 


Protection  this  good  comes  from  those  who 
know  you  best.  Who  are  there  to  look  out  for 
your  best  interests.  Who  understand  your 
special  needs. 

That’s  why  Colorado  physicians  and 
surgeons  can  put  their  trust  in  The  Doctors’ 
Company.  We’re  the  largest  doctor-owned, 
doctor-managed  professional  liability  insurer 
with  over  16,800  member-doctors 
nationwide.  And  we’ve  been  helping  good 
doctors  practice  better  medicine  since  1976. 

We  are  rated  “A  + ” (Superior)  by  A.M.  Best 
Company,  independent  analysts. 

The  Doctors’  Company  and  our  local 
Colorado  agents  provide  a level  of  service  that 
promises  to  ensure  your  peace  of  mind. 

If  you’re  not  already  covered  by  The  Doctors’ 
Company,  call  today. 

Endorsed  by  Denver  Medical  Society. 


When 

You’re 

Covered, 

You’re 

Covered 


The  Doctors'  Company 


Professional  Liability  Insurance 


For  more  information  call 

The  Doctors’  Company  — 800/42 1 -2368  ext  353 


1 993  Annual  Meeting 

September  9-12,  1993 

Snowmass  Conference  Center,  Snowmass,  Colorado 

Come , take  care  of  business,  enjoy  the  fall  colors  and  go  home  refreshed. 


See  the  following  pages  for  more  information... 


Colorado  Medicine  tor  August,  1993 


265 


COLORADO  MEDICAL  SOCIETY 
TENTATIVE  1 993  Annual  Meeting  Schedule 
Snowmass  Village,  CO 
September  9-1 2,  1 993 


Thursday,  Sept.  9 

1 :00  pm  

12:00  N -—4:00  pm 
1 :00  pm  — 2:30  pm 
2:30  pm  — 4:30  pm 
3:00  pm  — 6:00  pm 
5:00  pm  — 1 0:00  pm 
6:00  pm  — 7:00  pm 

7:00  pm  — 8:30  pm 


1 8-hole  Golf  Tournament — 
Snowmass  Club 
Arrange  Exhibit  Hall 
Finance  Committee 
Board  of  Directors 
CMS  Office  open 
Exhibitor  Set  Up 
Reception:  It's  a Jungle  Out 
There 

Dinner:  It's  a Jungle  Out  There 


NOTE.  Dress  for  Annual  Meeting — 

Thursday  evening  reception/dinner:  Jungle  safari 
or  casual 

Friday:  business  attire 

Saturday  morning:  casual 

Saturday  reception/dinner:  coat  and  tie/dressy 

business  attire  or  cocktail  dress 

Sunday:  casual 


Friday,  Sept.  1 0 

7:00  am 

7:00  am  — 5:00  pm 
7:15  am  — 8:45  am 
7:15  am  — 8:45  am 
7:30  am  — 8:30  am 
8:00  am  -12:00  N 
8:30  am  — 9:00  am 
8:30  am  — 1 0:00  am 
9:00  am  — 9:30  am 
9:30  am  — T1 :45  am 
1 0:00  am  — 1 0:30  am 
1 0:1  5 am  — 1 1 :45  am 
12:00  N —1:30  pm 
12:00  N —1:30  pm 


1 :30  pm  — 1 :40  pm 
1 :30  pm  — 7:00  pm 
1 :30  pm  — 2:30  pm 
1 :30  pm  — 4:00  pm 
1 :30  pm  — 4:00  pm 
2:30  pm  — 3:30  pm 
3:30  pm  — 6:00  pm 
3:30  pm  — 6:00  pm 
5:30  pm  — 7:00  pm 


CMS  Office  opens 
Registration 

Congress  of  Medical  Specialties 
El  Paso  County  Caucus 
Reference  Cmte.  Breakfast 
Exhibits  open 
Credentials  Committee 
CMSA  BOD  Breakfast 
Opening  Session  - HOD 
General  Membership  Meeting 
Coffee  break 
CMSA  General  Meeting 
COMPAC/CMSA  Luncheon 
Managed  Care  Forum  presented 
by  PPAC 

COMPAC  General  Membership 
Exhibits  open  (refreshments) 
Copic  Risk  Management 
Reference  Committee 
Reference  Committee 
Copic  Risk  Management 
Reference  Committee 
Reference  Committee 
Exhibitor  Reception 


6:30  pm  — 7:30  pm 


6:00  pm  — 7:00  pm 
7:00  pm  — 9:00  pm 


7:00  pm  — 8:30  pm 


Colorado  Society  of  Internal 
Medicine  Annual  Meeting 
Women  in  Medicine  Reception 
Women  in  Medicine  Dinner/ 
Business  Meeting 
"Gone  But  Not  Forgotten" 
Dinner 


Saturday,  Sept.  1 1 

7:00  am CMS  Office  opens 

7 :00  am  — 1 :30  pm  Registration 
7:00  am  — 7:50  am  Educ.  Prog.  Cont.  Breakfast 
7:00  am  — 1 2:00  pm  Exhibits  open 
8:00  am  — 1 2:30  pm  Educational  Program  Survival 
Techniques  in  the  Health  Care 
Jungle 

12:30  pm  Recreational  Activities 

(golf,  tennis,  horseback  riding,  biking,  fishing, 
walking,  etc.)  Great  Outdoors!! 

4:00  pm  — 5:00  pm  Colorado  Medical  Directors 
Association 

5:00  pm 6:00  pm  Cash  Bar 

6:00  pm  — 7:00  pm  Inaugural  Address 

7:00  pm  —1 1 :30  pm  Presidents'  Dinner/Dance 
8:30  pm  — 1 1 :30  pm  Copic  Dessert  Reception 

Sunday,  Sept.  1 2 

6:30  am Ref.  Cmte  Reports  available 

7 :0Q  am CMS  Office  opens 

7 :00  am  — 1 2 :00  N Registration 

7:00  am  — 8:30  am  Component  Caucuses 

Arapahoe 

Aurora-Adams 

Boulder 

Clear  Creek  Valley 

Denver 

- El  Paso 

Larimer/Weld 

Pueblo/Western  Slope 

8:00  am  — 8:30  am  Credentials  Committee 

8:00  am  — 9:00  am  CMSA  Gavel  Club  Breakfast 
8:30  am  — 1 2:00  N Closing  Session  HOD 

9:00  am  — 1 1 :00  am  CMSA  Program 

12:00  N (or  immediately  following  HOD) 

Nominating  Committee 

I 2:00  N (or  immediately  following  HOD) 

- Reorganizational  Board 


266 


Colorado  Medicine  for  August,  1993 


Tentative  Annual  Meeting  Registration 

1993  Annual  Meeting  of  the  Colorado  Medical  Society,  September  9-12,  1993,  Snowmass  Conference  Center 

Name  (please  print) 

Name  of  Spouse/Guest  (s)  (if  attending)  

Component  Society Office  Phone 


Please  check  all  that  apply 


O Women  in  Medicine 
Section 

O Young  Physicians 
Section 

□ Resident  Physicians 
Section 

O Component  Society 
Executive 

□ Program  Speaker 

□ Press 

O Other 

If  you  are  not  a member  of  CMS,  please  provide  the  following: 

Company/Organization  Title 


Reservations  for  Events  and  Meetings 

Reservation  deadline  is  August  27,  1993.  Reservations  accepted  on  a first-come,  first-served  basis  (may  be  limited 
for  some  programs).  For  purposes  of  registration,  staff  of  county  medical  societies  are  considered  members.  Please 
indicate  the  number  of  attendees  for  each  function,  even  if  there  is  no  charge,  so  that  we  may  be  cost  efficient  with 
food/beverage  orders. 

As  a member,  you  and  one  guest  are  entitled  to  attend  the  complimentary  events  at  no  charge.  Please  indicate 
the  number  of  additional  guests  at  the  bottom  of  this  form  and  enclose  your  check. 


Complimentary  events  open  to  ail  members: 


6:00  pm 

Reception:  It's  a Jungle  Out  There 

member  D 

guest 

7:00  pm 

Dinner:  It's  a Jungle  Out  There 

member  LJ 

guest 

September  10 

5:30  pm 

Exhibitor  Reception 

member  l_) 

guest 

6:00  pm 

Women  in  Medicine  Reception 

member  LI 

guest 

\y,  September  1 1 

7:00  am 

Educational  Program  Continental  Breakfast 

member  D 

guest 

8:00  am 

Educational  Program 

member  Q 

guest 

7:00  pm 

President's  Dinner  Dance  (please  select  menu  below) 

Beef  Dinner 

member  LI 

guest 

Chicken  Dinner 

member  D 

guest 

8:30  pm 

Copic  Dessert  Reception 

member  D 

guest 

a 


Non-Complimentary  Events:  Cost  Number 

Friday,  September  10 

8:30  am  CMSA  BOD  Breakfast $12  each  

12  Noon  COMPAC/CMSA  Luncheon  $15  each 

1 2 Noon  Managed  Care  Forum  presented  by  PPAC $15  each 

7:00  pm  Women  in  Medicine  Dinner/Business  meeting $25  each 


Total  for  Non-Complimentary  Reservations  $ 

Additional  Reservations  (other  than  member  + 1 guest): 

Reception:  It's  a Jungle  Out  There  # @$10each=  

Dinner:  It's  a Jungle  Out  There  # @$25  each=  

Educational  Program  Breakfast  # @$15  each= 

President's  Dinner  Dance  (please  select  menu  below) 

Beef  Dinner  # @$40  each=  

Chicken  Dinner  # @$40  each= 


Total  for  Additional  Reservations  $ 


$ 


Total  enclosed  for  non-complimentary  and/or  additional  reservations 


SNOWMASS  RESORT  ASSOCIATION 
Summer  1993  Baby  Sitting  List 
By  Category 


NAME 

AGE 

HOME 

WORK 

DAYS 

Bliss,  Chonnie 

26 

923-4176 

McCarty,  Barbara 

45 

927-3687 

963-0142 

EVENINGS 

Arnold,  Debbie 

38 

923-2427 

923-2420 

Bliss,  Chonnie 

26 

923-4176 

Buesch,  Silke 

28 

923-5610 

Comerford,  Mary  Jo 

29 

923-5095 

923-5095 

Huffman,  Carole 

46 

923-6168 

Markwood,  Susan 

31 

920-5555 

923-6059 

McCarty,  Barbara 

45 

927-3687 

963-0142 

McGee,  Carole 

55 

923-6768 

925-4061 

Muth,  Christy 

24 

923-3071 

923-4000 

Parks,  Jaclynn 

36 

923-6616 

923-5200 

Reeds,  Judi 

26 

923-2910 

923-4000 

Rizzo,  Andrea 

39 

963-1675 

923-2450 

Robertson,  Darlene 

30 

923-5271 

923-2000 

Saunders,  Victoria 

28 

923-2450 

923-3550 

Scott  Allison 

44 

927-3323 

923-2000 

Walnock,  Robin 

25 

923-6353 

923-3550 

FLEXIBLE 

Adair,  Patty 

39 

923-2446 

923-2446 

Adams,  Vanessa 

30 

923-5743 

923-4310 

Arnold,  Debbie 

38 

923-2427 

923-2420 

Arnold,  Melissa 

14 

923-242  7 

Blankenau,  Theresa 

29 

963-8546 

923-2000 

Bliss,  Chonnie 

26 

923-4176 

Buesch,  Silke 

28 

923-5610 

Dion,  Mariette 

51 

923-4681 

923-5600 

Hassinger,  Kellie 

27 

923-2936 

923-3636 

Jarrett,  Elaine 

38 

923-5389 

923-5600 

Markwood,  Susan 

31 

923-6059 

920-5555 

McCarty,  Barbara 

45 

927-3687 

963-0142 

Saunders,  Victoria 

28 

923-2450 

923-3550 

Vhrin,  Georgette 

42 

923-2988 

923-2988 

Walnock,  Robin 

25 

923-6353 

923-3550 

WEEKENDS 


Arnold,  Debbie 

38 

923-2427 

923-2420 

Arnold,  Melissa 

14 

923-2427 

Bliss,  Chonnie 

26 

923-4176 

Buesch,  Silke 

28 

923-5610 

Comerford,  Mary  Jo 

29 

923-5095 

923-5095 

Huffman,  Carole 

46 

923-6168 

Markwood,  Susan 

31 

920-5555 

923-6059 

McCarty,  Barbara 

45 

927-3687 

963-0142 

McGee,  Carole 

55 

923-6768 

925-4061 

Parks,  Jaclynn 

36 

923-6616 

923-5200 

Rizzo,  Andrea 

39 

963-1675 

923-2450 

Saunders,  Victoria 

28 

923-2450 

923-3550 

Scott  Allison 

44 

927-3323 

923-2000 

Walnock,  Robin 

25 

923-6353 

923-3550 

WEEKEND  DAYS 


Arnold,  Debbie 

38 

923-2427 

923-2420 

Arnold,  Melissa 

14 

923-2427 

Bliss,  Chonnie 

26 

923-4176 

Buesch,  Silke 

28 

923-5610 

Comerford,  Mary  Jo 

29 

923-5095 

923-5095 

Huffman,  Carole 

46 

923-6168 

McCarty,  Barbara 

45 

927-3687 

963-0142 

McGee,  Carole 

55 

923-6768 

925-4061 

Parks,  Jaclynn 

36 

923-6616 

923-5200 

Rizzo,  Andrea 

39 

963-1675 

923-2450 

Saunders,  Victoria 

28 

923-2450 

923-3550 

Scott  Allison 

44 

927-3323 

923-2000 

Walnock,  Robin 

25 

923-6353 

923-3550 

Phone  prefixes  927-  and  963-  are  downvaliey.  Please  try  to  provide  12-24  hours  notice. 

This  list  is  provided  by  the  Colorado  Medical  Society  and  the  Snowmass  Resort  Association  as  a service  to  our 
members.  We  do  not  necessarily  endorse  or  recommend  any  of  these  babysitters.  Each  sitter  has  provided  the  Snow- 
mass Resort  Association  with  Letters  of  Reference;  however,  neither  the  Snowmass  Resort  Association  nor  the 
Colorado  Medical  Society  assumes  any  liability  for  the  sitters  on  the  list. 


268 


Colorado  Medicine  for  August,  1993 


JES 


11E  JUNGLE 


i1  j/i 

I Jl  > 


am  — 10:10 
10:10  am  -10:30 
10:30  am  — 1 1 :10 


11:10  am  — 1 1 :40  am 


1 1 :40  am -12:00  N 
12:00  N-12:15  pm 


12:1  5pm - 1 2:30  pm 


. Carl  Bailey,  MD,  CMS  President-Elect 

Opening  segment 

Within  the  new  framework  of  health  care  reform, 
physicians  will  be  facing  a number  of  problems. 
Relationships  with  corporations  have  been  identi- 
fied as  one  of  those  problems. 

Speaker:  Lonnie  Bristow,  MD,  Chairman,  AMA 
Board  of  Trustees 

ariel  discussion:  Physician-corporate  relations 
This  panel  will  focus  on  the  "corporate"  relation- 
ships that  physicians  will  be  facing,  including 
physician-hospital,  and  physician,  hospital,  or 
insurance  company  controlled  networks. 

Panelists:  Lonnie  Bristow,  MD,  William  Varan i,  MD, 
Dennis  Brimhall,  and  an  insurance  industry  repre- 
sentative. 

Moderator:  Leigh  Truitt,  MD,  CMS  President 

Question/Answer  Session 

Break 

Overview:  Mid  Level  Providers 

The  second  segment  will  focus  on  building  partner- 
ships with  nurse  practitioners,  physician  assistants, 
and  others.  Within  the  new  context  of  health  care 
reform,  use  of  mid  level  providers  will  be  increased 
in  an  attempt  to  make  health  care  more  accessible 
in  underserved  populations. 

Speaker:  (tentative)  M.  Roy  Schwarz,  MD,  AMA  Sr. 
VP,  Medical  Education  and  Science 

Panel  discussion:  Physician-Mid  Level  Provider 
Relationships 

This  panel  will  focus  on  helping  physicians  under- 
stand the  role  of  mid  level  providers  and  be  more 
comfortable  in  creating  professional  relationships 
with  them. 

Panelists:  joe  Ferguson,  MD,  a nurse  practitioner, 
and  a physician  assistant 
Moderator:  A rural  physician 

Question/Answer  Session 
Closing  summary 

Wm.  Carl  Bailey,  MD,  CMS  President-Elect 

Final  Questions/Answer  Session 


Colorado  Medicine  for  August,  1993 


269 


Chair  of  AMA  Trustees  to  Speak 
at  '93  Annual  Meeting 


Lonnie  R.  Bristow,  MD 


Lonnie  R.  Bristow,  MD,  an  inter- 
nist from  San  Pablo,  California,  was 
elected  chairman  of  the  American 
Medical  Association  (AMA)  Board  of 
Trustees  at  the  Annual  Meeting  in  Chi- 
cago in  June,  1993.  He  had  been  re- 
elected to  Board  and  to  the  Executive 
Committee  in  June,  1991.  In  June,  1 992 
he  was  elected  vice  chair  of  the  AMA. 
Dr.  Bristow  has  served  as  an  AMA 
commissioner  to  the  Joint  Commission 
on  Accreditation  of  Healthcare  Orga- 
nizations since  June  1 990  and  contin- 
ues in  that  capacity.  His  service  on  the 
AMA  Education  and  Research  Foun- 
dation includes  serving  first  as  its  sec- 
retary-treasurer from  1986  to  1988, 
and  then  as  its  president  from  1 988  to 
1990. 

Before  his  election  to  the  Board  in 
June  1985,  Dr.  Bristow  served  as  an 
alternate  delegate  since  1 978  and  as  a 
delegate  since  1 981  to  the  AMA  House 
of  Delegates  from  the  American  Soci- 
ety of  Internal  Medicine.  In  1979  he 
became  a member  of  the  AMA's  Coun- 
cil  on  Medical  Service,  which  he 
chaired  from  1 983  until  his  election  to 
the  Board  of  Trustees. 

Dr.  Bristow  has  long  been  active  in 
organized  medicine.  Among  the  posi- 
tions he  has  held  are  chair  of  the  Sec- 
tion on  Internal  Medicine  of  the  Cali- 
fornia Medical  Association  and  presi- 
dent of  the  California  Society  of  Inter- 
nal Medicine  and  the  American  Soci- 
ety of  Internal  Medicine.  He  was  also 
honored  in  1977  by  his  election  to 
membership  in  the  Institute  of  Medi- 
cine of  the  National  Academy  of  Sci- 
ences. 

Dr.  Bristow's  service  in  the  profes- 
sional community  has  been  and  con- 
tinues to  bediverseas  illustrated  by  his 
appointmentto  serve  on  the  Institute  of 
Medicine's  Committee  on  the  Effects 


of  Medical  Professional  Liability  of  the 
Delivery  of  Maternal  and  Child  Health 
Care  from  1987  to  1989,  his  appoint- 
ment by  the  Surgeon  General  to  serve 
on  the  Federal  Interagency  Committee 
on  Smoking  and  Health  in  1988,  and 
his  appointment  by  the  Secretary  of 
Health  and  Human  Services  to  serve 
on  both  the  Center  for  DiseaseControl's 
HIV  Prevention  Advisory  Committee 
and  the  1989  Quadrennial  Advisory 
Council  on  Social  Security. 

Born  April  6,  1930,  Dr.  Bristow 
received  his  BS  degree  from  the  Col- 
lege of  the  City  of  New  York  in  1953 
and  his  MD  degree  in  1957  from  New 
York  University  College  of  Medicine. 
He  completed  his  internship  in  1 958  at 
San  Francisco  City  and  County  Hospi- 
tal and  served  his  residency  in  internal 
medicine  at  U.S.V.A.  Hospital,  San 
Francisco,  Francis  Delafield  Hospital 
(Columbia  University  Service)  New 
York  City,  and  U.S.V.A.  Hospital, 
Bronx,  New  York.  In  1981  he  com- 
pleted a residency  in  occupational 
medicine  at  the  University  of  Califor- 
nia, San  Francisco,  School  of  Medi- 
cine. Dr.  Bristow  is  a diplomate  of  the 
American  Board  of  Internal  Medicine 
and  a fellow  of  the  American  College 
of  Physicians.  He  is  on  the  staff  of 
Brookside  Hospital,  San  Pablo,  Cali- 
fornia. 

Dr.  Bristow  has  written  and  lec- 
tured extensively  on  medical  science 
as  well  as  on  socioeconomic  and  ethi- 
cal issues  related  to  medicine.  He  has 
served  as  a reviewer  for  the  journal  of 
the  A meric  a n Medical  A ssocia  tion  and 
on  the  editorial  advisory  boards  of 
three  other  publications,  including 
Medical  World  News. 

Dr.  Bristow  is  the  father  of  three 
children.  He  and  his  wife,  Marilyn, 
reside  in  Walnut  Creek,  California. 


270 


Colorado  Medicine  for  August,  1993 


CMS  Annual  Meeting  Golf  Tournament 

at  The  Snowmass  Club 
Thursday,  September  9,  1993 
Entry  Form 


Name 


Address  

Please  give  us  the  following  information  for  tee  times  and  emergencies 


Office  Phone Home  Phone 

While  at  Snowmass  I will  be  staying  at 


FAX#  

(Needed  for  tee  times) 


I will  be  attending  the  meeting  in  the  capacity  of  (check  one) 

O Physician  O Exhibitor  O Spouse  O Other 

I will:  O Sponsor  a golf  course  hole  @$100  □ Sponsor  a putting  green  contest  hole  @$50 

Name  of  sponsor  (as  you  wish  it  to  appear  on  sign)  

(Professionally  made  signs  will  be  displayed  for  sponsors.  All  proceeds  will  directly  benefit  the  CMS  Medical  Indigence  P**rogram) 

My  golf  handicap  is O USGA  O Other 

I will  require  rental  clubs  @ $1 8 O Left  handed  □ Right  handed 

Play  will  be  scramble  format.  Foursomes  will  be  arranged  according  to  various  levels  of  ability  by  the  golf  professional.  If  you 
have  a preference  of  who  you  are  teamed  with,  please  specify  below.  Prizes  will  be  awarded  for  a variety  of  categories  to  include 
closest  to  the  pin  and  longest  drive.  To  ensure  tournament  entry,  registration  form  and  advance  payment  of  $84  must  be  received 
no  later  than  August  1 6,  1 993.  Cancellations  received  after  August  30,  1 993  are  refundable  subject  to  ability  of  Snowmass  Resort 
Association  to  "resell"  vacated  tee  times. 

A shotgun  start  will  not  be  possible,  therefore,  please  be  prompt  with  your  tee  times.  To  reserve  personal  tee  times,  please  call 
the  Snowmass  Pro  Shop  at  923-3148. 

I prefer  to  be  teamed  with 

Mail  Entry  Form  and  check  for  $84  to  Specialty  Media,  P.  O.  Box  36357,  Denver,  CO  80236.  For  additional  information,  call 
Tim  jackson  at  303-986-5926. 


Lodging  Reservation  Form 

Name  

Address  

City State Zip Daytime  phone  ( ) 

Total  in  party  Adults Children Ages  of  children  

□ This  is  to  confirm  phone  reservations 

Arrival  date  Departure  Date  

MC/Visa#  (if  appropriate) Exp.  date 

I wish  to  reserve:  (these  special  rates  apply  from  September  6-15,  1993) 

□ Silvertree  Hotel  Lodge  Room  ($98  per  night  for  2 persons,  each  additional  $15,  under  12  free) 

□ Mountain  Chalet  Lodge  Room  ($80  per  night  for  2 persons,  each  additional  $10,  under  12  free) 

Note:  Reservation  cut  off:  August  9, 1993.  One  night’s  lodging  required  as  deposit. 

CANCELLATION  POLICY:  If  you  cancel  more  than  30  days  before  arrival  you  receive  full  refund,  less  $25  cancellation 
fee.  Thirty  days  or  fewer,  you  forfeit  one  night's  rent,  or  $25  cancellation  fee  if  re-rented. 

Send  completed  Reservation  Form  to 
Snowmass  Resort  Association,  PO  Box  5566,  Snowmass  Village,  CO  81615 
Central  Reservations — (303)  923-2010  1-800-598-2004  (nation-wide) 


Colorado  Medicine  for  August,  1993 


271 


'93  Science  Fair  Winners 
at  Annual  Meeting 


Photos  by  Gil  Maestas.  II 
Communications  Specialist,  CMS 


Medical  Society  Promotes  Science  Education 


The  Colorado  Medical  Society 
sponsored  awards  for  two  students  in 


the  38th  Annual  Colorado  State 
Science  Fair  in  April.  The  purpose  of 
these  awards  was  to  encourage 
young  people  to  pursue  scientific 
education  and  to  motivate  them 
toward  the  possibility  of  a career  in 
medicine. 

In  the  Junior  Division,  Ashley 


Kircher's  project,  Blood  on  the 
Counter:  What  is  the  Risk  of  Acquir- 
ing Infection?  ex  amined 
how  long  and  at  what 
distance  a spilled  blood 
sample  would  remain 
contagious.  Ms.  Kircher  is 
an  eighth 
grade  student 
at  North  Junior 
High  School  in 
Colorado 
Springs. 

It  was  a 
close  contest 
in  the  Senior 
Division.  Warren  Gasper 
of  Fort  Collins  and  Diann 
Miyake  of  Cherry  Creek 
were  last  year's  winners 
and  both  repeated  their 
outstanding  performances. 

Colleen  Morgan,  a senior  at  Cherry 
Creek  High  School  barely  surpassed 


them  with  her  project,  Using  the 
Polymerase  Chain  Reaction  to 
Identify  Estrogen  Receptor  MRNA  in 
Gliobastoma  Cell  Lines. 

Both  of  these  students  will  be 
presented  with  US  Savings  Bonds 
and  will  exhibit  their  projects  at  the 


Annual  Meeting.  Stop  by  for  a 
fascinating  earful. 


y<M.! 

The  Colorado  Medical  Society  wishes  to  thank  the  following  corporations, 
their  support  of  the  7 993  Annual  Meeting. 


Blue  Cross/Blue  Shield  of  Colorado 
Chase  Manhattan  Investment  Ser- 
vices 

Children's  Corner 

College  Pharmacy 

Colorado  Air  National  Guard 

Copic  Insurance  Company 

Eli  Lilly  and  Company/Dista  Products 

Company 

First  Security  Leasing 
H.  A.  Safford,  III,  MD 


InfusionCare  of  Colorado 
Janssen  Pharmaceutica 
Knoll  Pharmaceutical  Company 
Marion  Merrell  Dow,  Inc 
MegaWest  Systems,  Inc. 

Merck 

MicroAge 

MONY  Financial  Services 
National  Jewish  Center  for  Immunol- 
ogy and  Respiratory  Medicine 
NMC  Homecare 


who  have  reserved  exhibit  space,  for 

Physicians  & Surgeons,  a division  of 
Fremont  Indemnity  Co. 

Roche  Laboratories 

Schering  Laboratories 

St.  Paul  Fire  and  Marine  Insurance 

Company 

The  Doctors'  Company 
The  Financial  Group 
Therex  Physical  Therapy 
Western  Heart  Institute — P/SL 
Medical  Center 
Wyoming  Air  National  Guard 


272 


Colorado  Medicine  for  August,  1993 


by  Robert  M.  Bogin,  M.D.,  Chair 
Health  Systems  Reform  Committee 
and 

Jo  Parkin,  Program  Director 
Division  of  Health  Care  Financing 


Health 


System 


Reform 


Health  System  Reform  Committee  debates  top  issues 


Over  the  last  few  months  the 

Health  System  Reform  Committee 
has  worked  to  identify  and  analyze 
important  issues  in  the  health  system 
reform  debate.  We  have  been  able 
to  reach  consensus  on  many  issues, 
and  we  will  be  developing  recom- 
mendations for  the  Board  of  Direc- 
tors and  House  of  Delegates  regard- 
ing health  system  reform.  Following 
are  some  excerpts  of  our  discussions 
on  these  topics. 

Universal  Access 

Existing  Colorado  Medical 
Society  policy  stresses  that  problems 
around  residency  requirements  need 
to  be  addressed.  It  was  pointed  out 
that  enforcement  of  any  residency 
requirements  will  leave  some  people 
without  coverage.  In  reality,  these 
people  will  probably  continue  to 
receive  care,  therefore,  consideration 
must  be  given  to  how  this  care  will 
be  financed.  The  committee  recom- 
mends that  policies  regarding 
residency  requirements  should 
discourage  people  from  moving  to 
Colorado  specifically  to  obtain 
health  care  coverage.  A combina- 
tion of  public  and  private  cost 
sharing  should  be  used  to  cover 
people  ineligible  due  to  residency 
requirements. 

Quality  of 

Quality  assurance,  utilization 
review  and  public  health  standards 
should  be  established  with  the  strong 
cooperation  and  participation  of  the 


REFERENCES 


1 M8CRA 

The  Medical  Injury  Compensation 
Reform  Act  (MICRA)  of  1 975  is  con- 
sidered the  best  malpractice  reform 
package  in  existence  today  and  one 
that  national  and  state  reforms  should 
be  modeled  after.  It  consists  of  four 
key  provisions:  1 ) a $250,000  limit 
on  non-economic  damages,  2)  peri- 
odic payment  of  future  damages,  3)  a 
requirement  that  the  jury  hear  evi- 
dence of  any  "collateral  source"  of 
compensation  for  a patient's  injuries, 
such  as  health  ordisability  insurance 
payments,  and  4)  a reasonable  slid- 
ing scale  limit  on  attorney  contin- 
gency fees,  which  ensures  that  a 
greater  portion  of  the  award  goes  to 
injured  patients  rather  than  to  cover 
attorney's  fees. 

2 Med  i Save 

MediSave  accounts  would  allow 
individuals  to  set  up  health  saving 
accounts  with  tax  free  contributions 
from  either  employers  or  individuals, 
or  a combination  of  both.  Individu- 
als would  then  purchase  health  in- 
surance with  a high  deductible,  and 
hold  the  balance  of  deposits  in  the 
account  to  pay  for  incidental  medi- 
cal expenses.  Any  unspent  funds 
would  roll  over  and  accrue  to  the 
ind  ividual. 


A central  premise  of  MediSave  is  to 
promote  consumers'  decision-mak- 
ing role  in  purchasing  health  insur- 
ance. To  the  extent  that  consumers 
shop  for  policies  that  best  serve  their 
needs,  a degree  of  competition  and 
cost-consciousness  could  be  restored 
to  the  market.  The  strategy  also  could 
provide  consumers  an  economic  in- 
centive to  look  after  their  general 
health  more  carefully.  Its  roll-over 
provisions  would  allow  consumers  to 
accumulate  savings  in  their  overall 
health  care  spending  - savings 
achieved  through  preventive  care  and 
health  maintenance. 

3 Point  of  Service 

Point  of  service  plans  combine  man- 
aged care  and  indemnity  features  into 
asinglehealth  insurance  product.  Sub- 
scribers of  these  plans  typically  re- 
ceive the  highest  level  of  benefits  when 
they  use  a primary  care  physician  to 
manage  their  care  and  coordinate  re- 
ferral services.  However,  members 
can  also  receive  medical  care  from 
any  qualified  medical  care  provider 
without  a referral  if  they  choose.  When 
they  choose  this  self-referral  option, 
they  have  a greater  out  of  pocket 
expense. 


Colorado  Medicine  for  August,  1993 


273 


Health  System  Reform 


medical  profession.  Physician  care 
standards  should  be  determined  by 
the  medical  profession.  Equally 
important  to  monitoring  the  quality 
of  medical  care  should  be  the 
monitoring  of  the  performance  of 
health  plans. 

Malpractice  Reform 

The  committee  recommends 
adding  to  existing  CMS  policy 
support  for  the  Medical  Injury 
Compensation  Reform  Act  of  1975 
(MICRA)1,  California's  medical 
malpractice  reform. 

Benefit  Package 

Any  meaningful  health  system 
reform  plan  will  require  society  to 
make  difficult  choices  regarding  the 
complex  and  sensitive  bioethical 
issues  we  face  in  an  era  of  expanding 
technology  and  limited  resources. 
True  cost  effective  care  must  be 
emphasized  and  physicians  must 
retain  their  traditional  role  as  patient 
advocate. 

Funding 

The  committee  recommends 
adding  a provision  to  oppose 
provider  taxes  citing  specific  reasons 
why  provider  taxes  are  opposed. 
Some  of  the  reasons  include: 

• Provider  taxes  ultimately  get 
passed  through  to  patients  in 
the  form  of  higher  charges. 

Since  sick  people  seek  medical 
care  more  often  than  healthy 
people,  this  will  more  nega- 
tively impact  sick  people. 


• Implementing  provider  taxes 
creates  a taxation  system  that 
currently  does  not  exist  and, 
consequently,  will  increase 
administrative  costs  associated 
with  the  new  tax. 

Global  Budgets 

CMS  has  an  existing  policy 
opposing  global  budgets,  but  this 
issue  is  not  specifically  addressed  in 
CMS'  health  system  reform  policy. 
The  group  recommends  that  a 
statement  on  global  budgets  be 
added  to  this  policy.  It  also  agreed 
that  if  we  oppose  global  budgets  we 
need  to  say  why  and  perhaps  offer 
alternative  ways  to  achieve  the  same 
level  of  cost  savings.  The  underlying 
concern  is  that  there  not  be  an 
arbitrary  limit  set  on  health  care 
spending  after  which  people  do  not 
get  the  care  they  need  or  face 
waiting  lines  etc. 

Cost  Containment 

Appropriate  incentives  need  to 
be  built  into  any  health  care  system 
which  encourage  patients  to  make 
cost  effective  decisions  about  their 
health  care.  Medisave2  accounts 
and  other  health  IRA  arrangements 
are  supported.  Appropriate  incen- 
tives also  need  to  be  built  in  which 
encourage  physicians  to  provide 
appropriate  care. 

Physician  education  is  a corner- 
stone of  cost  containment.  There  is 
potential  for  significant  cost  savings 
by  educating  physicians  on  appro- 
priate prescribing  habits  for  pharma- 
ceuticals, durable  medical  equip- 
ment, choice  of  procedures  and  like 
issues. 


Continued... 


Addressing  excess  capacity 
within  the  health  care  system  is  an 
important  part  of  cost  containment 
efforts. 

Freedom  of  Choice 

Freedom  of  choice  by  patients 
to  choose  their  physician  through 
their  health  plan  should  also  include 
the  freedom  of  choice  of  patients  to 
choose  a specialist  of  their  selection. 
If  the  specialist  is  not  in  that  specific 
plan,  access  to  that  physician  should 
be  permitted  through  a point  of 
service3  option.  Quality  care  must 
be  assured  both  within  and  outside 
of  the  networks. 

Health  plans  have  a right  to  set 
standards  for  entry  into  or  continua- 
tion in  their  provider  panels.  Based 
on  those  standards,  they  are  entitled 
to  select  with  whom  they  will  or  will 
not  contract.  These  standards  should 
be  made  public  and  available  to 
physicians  prior  to  applying  for 
membership  on  a panel.  Physicians 
who  are  denied  access  into  a panel 
or  terminated  from  it  should  have  the 
right  to  an  appeal  process. 

Portability 

The  committee  recommends 
supporting  the  elimination  of  em- 
ployer-based insurance  as  one  way 
of  ensuring  portability.  Employers 
might  be  a source  of  funding  for 
health  care,  but  individual  consum- 
ers should  choose  their  specific 
health  plan. 

C/M 


274 


Colorado  Medicine  for  August,  1993 


Locum  Tenons 

Latin:  Holding  the  Place 

The  locum  tenens  industry  has 
evolved  into  a nationwide  mecha- 
nism for  physicians  to  find  interim 
coverage  for  their  medical  practices. 
While  originally  utilized  to  provide 
temporary  coverage  during  vacation 
or  illness  and  other  situations  in 
which  permanent  physicians  needed 
additional  support,  many  locum 
tenens  companies  now  provide  these 
services  as  a means  to  allow  physi- 
cians a trial  run  in  a potentially 
permanent  new  setting. 

Not  only  do  locum  tenens 
provide  some  protection  against  loss 
of  revenue  and  patients  for  a medical 
practice  and  continuity  of  care  for 
the  patients,  locum  tenens  physicians 
enjoy  flexible  schedules  and  the 
opportunity  to  experience  a broad 
range  of  practice  and  geographic 
settings  without  the  administrative 
hassles. 

CMS  has  become  aware  of 
several  locum  tenens  agencies 
available  for  use  by  Colorado 
physicians.  Some  of  them  have 
slightly  different  features  than  others. 
This  list  is  not  exhaustive,  nor  does  it 
imply  endorsement  of  any  agency.  It 
is  merely  a resource  for  physicians. 

Colorado  Medical  Society  303-779- 
5455  or  1-800-654-5653  Ellen  Stein  or 
Marilyn  Barton 

(Resource/matching  service  - will 
provide  names  and  guidelines  for 
establishing  locum  tenens  coverage. 

All  negotiations  up  to  you.  No  cost  to 
CMS  members) 


Health  Care 


This  list  is  not  exhaustive , nor  does  it  imply 
endorsement  of  any  agency. 


American  Medical  Association  312- 
464-5549  Project  Coordinator  Hattie 
Askew 

(Resource/matching  service  - will 
provide  names  and  guidelines  for 
establishing  coverage.) 

CompHealth  1-800-453-3030  Salt 

Lake  City 

(Provides  locum  tenens,  trial  practice 
options  and  permanent  placement  for 
a broad  range  of  specialties.) 

Doctors  to  the  USA  303-245-81  38 
Western  Colorado  Healthcare  Alli- 
ance— Steve  Ward 
(Hopes  to  be  operational  in  March, 
providing  locum  tenens  services  to  the 
Western  Slope  as  a part  of  recruitment 
efforts.) 

Interim  Physicians  1-800-669-0718  or 
303-691-0718  Medical  Director,  Ken 
Teufel,  MD;  Branch  Mgr,  Ed  Novelli- 
Regional  office  in  Colorado 
(Original  focus  on  primary  care, 
expanding  to  serve  all  specialties  in 
March.  Places  Colorado  physicians  in 
Colorado  locations,  decreasing 
outstate  travel  costs.) 

Jackson  and  Coker,  Inc.  850-7118 
(Covers  all  specialties  - provides 
services  for  temporary  coverage,  trial 
practice  options  and  permanent 
placement.) 

Kron  Medical  1 -800-MEDICAL 

President  and  Med.  Dir.,  Allan 
Kronhaus,  MD 

North  Carolina:  (Provides  coverage  for 
all  settings,  long  and  shortterm  and 
trial  practice/recruiting  options.) 
LOCUM  Medical  Group 
1-800-752-5515  Catherine  Flynn 
Cleveland:  (Short  and  long  term 
physician  staffing  for  most  specialties. 
Also  trial  practice/recruiting  options.) 


Project  USA  312-464-4702  Project 
Director,  John  Naughton 
(AMA  program  to  recruit  physicians  for 
Indian  reservations  and  rural  commu- 
nities during  absences  of  the  regularly 
assigned  Public  Health  Service 
doctors.) 

Spectrum  Emergency  Care  1-800-288- 
8044  St.  Louis:  Catherine  Hariston 
Staff  Care,  Inc.  1-800-685-2272  Client 
Services,  Rod  Arnold 
(Associated  with  Merritt  Hawkins 
physician  search  firm;  covers  broad 
range  of  specialties  for  long  or  short- 
term and  test  marketing  or  trial 
practice/  recruiting  options). 


Colorado  Medicine  for  August,  1993 


275 


Understanding 

Health  Care  Integration  Part  1 of  two  parts 

by  Ted  Lewis,  M.D. 


Ed:  The  following  is  the  first  of  a two-part  article  written  by  Dr.  Ted  Lewis  , Director  of  Medical  Education 
Penrose-St.  Francis  Hospital,  Colorado  Springs,  Colorado  and  published  in  the  Medical  Staff  Monthly,  May,  1 993. 


The  decade  of  the 
1 990s  is  likely  to  be 
looked  upon  by  future 
social  historians  and 
health  policy  analysts  as 
the  time  of  greatest 
change  in  the  American 
healthcare  industry.  They 
will  point  to  this  decade 
as  the  time  when  new 
principles  of  healthcare 
delivery  were  imple- 
mented. 


The  old  principles  focused  on  acute 
care,  provider  dominance  and 
individuals,  the  "illness"  model.  The 
new  model,  "wellness",  calls  on  new 
principles  based  upon  health  status 
prediction  and  management,  pro- 
vider-patient partnerships  and  a 
collective  population-based  focus. 

Health  policy  historians  will 
observe  that  this  paradigm  shift  was 
not  brought  about  by  national 
healthcare  reform  initiatives  during 
the  Clinton  Administration,  but  by 
forces  within  the  healthcare  industry 
that  began  in  the  1 970s  which  led  to 
the  development  of  organized 
delivery  systems.  These  organized 
delivery  systems  (HMO's,  FPO's, 
etc.)  developed  from  the  increasing 
need  to  address  the  issues  of  cost, 
new  technology,  the  impact  of 
chronic  illness  and  increasing 
longevity,  information  management 
and  the  emphasis  on  quality  of  care. 
These  organizations  served  as  a 
stimulus  for  the  fundamental  restruc- 
turing of  the  American  healthcare 
system. 

Basically,  an  organized  health- 
care delivery  system  is  an  organiza- 
tion or  network  that  provides  or 
arranges  to  provide  a coordinated 
continuum  of  services  to  a defined 
population  and  is  expected  to  be 
fiscally  and  clinically  responsible  for 
the  health  status  of  that  defined 
population.  It  may  own  or  at  least 
has  a close  relationship  with  an 
insurance  product.  Close  linkages 
with  public  health,  social  services 
and  other  community  based 
agencies  are  necessary. 

In  this  process,  a new  identity, 
the  "holographic"  organization 
emerges  as  a prototype  for  the  future 


delivery  system  for  healthcare.  There 
are  at  least  a dozen  of  these  proto- 
type organized  delivery  systems 
moving  into  the  new  paradigm  in  the 
United  States  today.  Nine  of  these 
organizations  are  involved  in  a 
collaborative  effort  with  the  J.  L. 
Kellogg  Graduate  School  of  Manage- 
ment and  the  Center  for  Health 
Service  and  Policy  Research  at 
Northwestern  University.  Now  two 
years  into  a three  year  study,  the 
findings  reveal  the  highest  degree  of 
perceived  integration  occurs  in  the 
functional  area  with  lower  levels  for 
physician  and  clinical  integration. 
Functional  integration  relates  to 
culture,  human  resources,  informa- 
tion systems,  non-clinical  support 
services,  marketing,  quality  assur- 
ance/improvement, strategic  plan- 
ning, financial  management  resource 
allocation,  and  financial  manage- 
ment operating  policies.  One  thing 
these  organizations  are  learning  first 
hand  is  that  integration  is  not  a quick 
and  easy  fix. 

It  is  important  to  begin  to 
understand  how  these  organizations 
are  changing  and  to  learn  from  their 
experience  into  these  yet  uncharted 
waters.  As  healthcare  providers,  we 
must  begin  to  make  that  paradigm 
shift  if  we  are  to  play  a major  role  in 
the  future  of  the  delivery  of  health- 
care in  this  country.  The  new 
paradigm  in  healthcare  has  a moral 
and  an  ethical  dimension,  requiring 
resource  sharing  and  collaboration, 
with  linking  to  the  future. 

Our  future  as  healthcare  provid- 
ers, physicians  and  hospitals  alike, 
will  be  in  the  business  of  health  not 
the  business  of  illness. 


276 


Colorado  Medicine  for  August,  1993 


YOU  ARE  INVITED 

To  participate  in  the  New  Physician/Student  MENTOR  PROGRAM! 


Dear  Colorado  Physician:  The 
CMS  Medical  Student  Component 
would  like  to  invite  you  to  become 
an  integral  part  of  its  new  MENTOR 
PROGRAM.  The  purpose  of  the 
program  is  to  allow  practicing 
physicians  to  guide  and  encourage  a 
medical  student  through  his/her 
years  of  school,  on  a one-on-one 
basis.  We  envision  close  relation- 
ships being  formed  between  the 
students  and  physicians,  allowing 
students  to  go  to  their  mentor  when 
they  need  a sounding-board,  advice, 
or  encouragement,  and  allowing  the 


Who  will  make  health  cart 
decisions  for  you  when  you 
cannot  ~ whether  it’s  an 
illness  or  disability.  Call  Ted 
Gelt,  head  of  our  estate 
planning  department,  to 
learn  the  peace  of  mind  a liv- 
ing will  and  durable  health 
care  power  of  attorney  can 
provide. 

GELT,  FLEISHMAN  & 
STERLING  EC 

• attorneys  and 

COUNSELORS  AT  LAW 

SUITE  2600 
1600  BROADWAY 
DENVER,  COLORADO1 80202 

(303)  861-1000 


physician  to  give  of  his/her  own 
wealth  of  experience  while  keeping 
in  touch  with  medical  education.  In 
general,  our  program  will  match 
students  with  mentors  in  a very  fluid, 
flexible  and  largely  student  -initiated 
way.  The  program  will  allow  free- 
dom for  both  the  students  and 
physicians  to  investigate  more  than 
one  mentor/protege  relationship,  as 
necessary,  to  find  a good,  lasting 
"match". 

Throughout  the  year,  we  plan  to 
support  the  mentors  in  their  impor- 
tant role  with  educational  materials 
and  ideas  about  how  to  mentor 
effectively.  Many  of  you  may  also 
have  your  own  ideas  which  you  may 
want  to  share  with  us,  so  we  can 
share  them  with  others. 

If  you  are  interested  in  becoming 
a mentor  to  a CU  medical  student, 
please  call  (303)  321-8860.  Leave 
your  name,  address  and  phone 
number,  and  we  will  get  back  to  you 
with  additional  information.  As 
practicing  physicians,  you  represent 
a wonderful  resource  to  the  develop- 
ing students  who  will  follow  your 
steps  in  just  a few  years.  We  would 
like  to  thank  you  in  advance  for 
participating  in  the  Mentor  Program  . 
It  promises  to  be  a worthwhile 
experience  for  everyone  involved.  If 
you  have  already  signed  up  to 
become  a mentor  through  the 
Women  in  Medicine  Section  of  CMS, 
you  are  automatically  included  in 
this  program,  so  we  are  asking 
nothing  more  from  you  at  this  time. 
Thank  you. 

Theresa  A.  Scholz,  MSIV 
CMS  Board  of  Directors 


Theresa  A.  Scholz , MSIV 
represents  the  Medical 
Student  Component  on 
the  CMS  Board  of 
Directors. 


Colorado  Medicine  for  August,  1993 


277 


Medical 


News 


Dr.  Tom  Vernon  joins  Merck 


i ,r*U\ 


Thomas  M.  Vernon,  M„ 


appointed  to  the  n 
executive  director 


Thomas  M. 
Vernon,  M.D., 
former  Executive 
Director  of  the 
Colorado 
Department  of 
Health  under 
Governors 
Richard  Lamm 
and  Roy  Romer, 
has  been 
m position  of 
for  medical, 


scientific  and  public  health  affairs, 
Merck  Vaccine  Division.  The 
announcement  was  made  on  July  1 3, 
1993,  by  R.  Gordon  Douglas,  |r., 
M.D.,  President  of  Merck  Vaccine 
Division.  In  his  new  position,  Dr. 
Vernon  is  responsible  for  a broad 
range  of  activities  of  stratigic  impor- 
tance in  the  fields  of  medicine, 
science  and  public  health  as  they 
relate  to  the  activities  of  the  Division. 
The  division  discovers,  develops  and 
markets  childhood  and  adult  vac- 
cines. 


Prior  to  joining  Merck,  Dr. 
Vernon  served  as  the  director  of 
health  and  human  services  at  The 
Pew  Charitable  Trusts  in  Philadel- 
phia. He  currently  serves  as  chair- 
man of  the  board  of  directors  of  the 
National  Center  for  Lead  Safe 
Housing  and  he  also  chairs  a techni- 
cal advisory  committee  for  The 
Robert  Wood  Johnson  Loundation. 

The  Merck  Vaccine  Division,  a 
unit  of  Merck  & Co.,  Inc.,  was 
created  in  1991  and  is  headquar- 
tered in  Whitehouse  Station,  N.  J. 


FLIGHT  SURGEONS 
WANTED. 

Discover  the  thrill  of  flying,  the  end  of 
paperwork  and  the  enjoyment  of  a gener- 
al practice  as  an  Air  Force  flight  surgeon. 
Take  flight  with  today’s  Air  Force  and  dis- 
cover quality  benefits,  30  days  of  vaca- 
tion with  pay  each  year  and  the  support 
of  a dedicated  staff  of  professionals. 

Enjoy  a true  general  practice  on  the 
ground,  with  the  kind  of  stimulating  chal- 
lenge that  will  get  your  medical  skills  air- 
borne. Talk  to  an  Air  Force  medical  pro- 
gram manager  about  becoming  an  Air 
Force  flight  surgeon.  Call 

1-800-423-USAF 
USAF  Health  Professions 


278 


Colorado  Medicine  for  August,  1993 


DEPARTMENT 

OFAHEALTH 


Health  D 


Vincent  Carroll,  Editorial  Page  Editor 
Rocky  Mountain  News 
July  8,  1993 

Dear  Vince: 

We  were  very  disappointed  in  the 
views  expressed  in  your  June  27th 
editorial  about  violence.  Public 
health  thinking  breaks  with  the 
traditional  viewpoint  and  refocuses 
on  the  premise  that  violence  is 
preventable.  Applying  new  analyses 
to  the  issue  of  violence  in  our 
communities  can  make  a substantial 
contribution  to  reducing  the  deaths, 
injuries  and  fear  resulting  from  that 
violence. 

Applying  public  health  prin- 
ciples to  epidemic  problems  in  our 
society  is  not  new,  and  it  is  not  the 
same  as  saying  "Violence  is  a 
disease",  although  many  describe  it 
as  a cancer.  We  have  successfully 
applied  the  principles  of  identifying 
the  characteristics  of  the  victims  and 
the  environment  that  lead  to  injury 
or  disease,  using  that  information  to 
devise  prevention  strategies,  and 
evaluating  the  success  of  these 
strategies  before. 

The  Colorado  Department  of 
Health  is  documenting  the  extent  of 
injuries  due  to  violence  in  the  state, 
our  surveillance  role.  The  death  rate 
due  to  homicide  and  suicide  in 
Colorado  increased  from  8.8/ 

1 00,000  in  1 992,  more  than  dou- 
bling. Using  media  sources  to 
supplement  death  certificate  infor- 
mation, the  Injury  Epidemiology 
Program  identified  610  violent 
injuries,  including  shootings,  knif- 
ings, beatings  and  sexual  assaults,  in 
the  seven-month  period  from 
October,  1992  to  April,  1993.  These 
injuries  resulted  in  272  deaths. 


The  Child  Fatality  Review 
Committee,  established  in  1989, 
studies  child  deaths  throughout  the 
state,  carefully  identifying  those 
related  to  neglect  and  abuse.  The 
epidemiology  of  these  deaths  will 
lead  to  potential  interventions  to 
prevent  deaths  from  child  abuse.  A 
similar  approach  to  preventing 
domestic  violence  has  led  to  special 
training  programs  for  emergency 
room  personnel  and  physicians  in 
recognizing  and  intervening  to  stop 
domestic  violence. 

The  Colorado  Board  of  Health 
has  established  the  Violence  Preven- 
tion Advisory  Committee  to  analyze 
the  available  information  and 
develop  public  health  approaches  to 
preventing  violence.  The  Committee 
has  more  than  fifty  members, 
including  community  and  law 
enforcement  agencies.  The  close 
relationship  between  substance 
abuse  (both  alcohol  and  illicit  drugs) 
and  violence  is  one  factor  the  group 
is  actively  considering.  Reducing 
drug  abuse  has  required  concerted 
prevention  strategies,  education, 
treatment  and  law  enforcement 
efforts. 

Changing  the  current  epidemic 
of  violence  requires  the  collabora- 
tion of  many,  including  law  enforce- 
ment, criminal  justice,  health,  social 
service,  and  education  agencies. 
Using  strategies  of  surveillance, 
epidemiology  and  health  promotion 
can  help  reduce  violence.  These 
strategies  help  shift  our  efforts  to 
prevention  of  violent  events. 

It  is  unwise  to  eliminate  without 
serious  consideration  new  or  differ- 
ent approaches  to  reducing  violence. 
Clearly,  our  methods  have  not  been 
wildly  successful. 


Patricia  A.  Nolan,  MD,  MPH 
Executive  Director 
Colorado  Department  of  Health 


Colorado  Medicine  for  August,  1993 


279 


Medical 


News 


PLEASE  NOTE: 
Information  about 
Advanced  Directives 

Ordering 

Advanced  Directives  Forms 

Regarding  the  new  CPR  forms,  they 
must  be  ordered  by  each  physician. 
They  will  not  be  sent  to  any  physi- 
cian office  or  clinic  without  a 
specific,  paid  order  for  the  forms. 

You  can  order  the  CPR  forms 
only  through  CMS.  Call  Ms.  Wood  at 
779-5455  or  1-800-654-5653  to 
obtain  pricing  information  or  to 
place  your  order. 

Education  about 
Advanced  Directives 

Following  patient  wishes  is  now 
easier  in  Colorado.  The  Colorado 
Patient  Autonomy  Act  became  law 
last  year  and  is  now  in  effect.  It 
encompasses  medical  durable 
powers  of  attorney,  proxy  decision- 
making for  patients  who  have  lost 
decisional  capacity,  and  CPR 
directives  (DNR  orders  with  a 
standardized  statewide  form,  neck- 
lace, or  bracelet). 

Colorado  ACEP  (American 
College  of  Emergency  Physicians) 
has  developed  a slide  presentation 
designed  to  educate  physicians 
about  Colorado's  new  law.  This  slide 
presentation  is  available  on  loan 
from  Colorado  ACEP  to  CMS  mem- 
bers. 

Contact  Diana  Wood  at  CMS 
(779-5455)  or  Dr.  Carla  Murphy  at 
Lutheran  Medical  Center  Emergency 
Department  (425-2089)  if  you  wish 
to  make  use  of  this  resource. 


EACH/RPCH  PROJECT:  Update 


The  Rural  Health  Network 
Development  Grant  which  creates 
networks  between  Essential  Access 
Community  Hospitals  (EACH)  and 
Rural  Primary  Care  Hospitals 
(RPCH)  is  underway  in  Colorado. 
Following  is  a brief  summary  of  the 
activities  in  the  communities 
involved  in  this  project: 

Kremmling  Hospital/Routt  Memo- 
rial Hospital  in  Steamboat  Springs: 

Kremmling  has  a new  mam- 
mography machine  in  place;  a 
teleradiology  unit  permits  consulta- 
tion by  Routt  County  radiologists. 
New  radios  have  been  purchased 
for  EMS  equipment  to  eliminate 
dead  areas  between  the  two 
communities.  Routt  County  has 
purchased  an  air  module  for  one  of 
their  helicopters  for  emergency 
transfers.  Discussions  are  taking 
place  to  have  Steamboat  Springs 
physicians  provide  specialty  clinics 
in  Kremmling. 

Haxtun  District  Hospital/Sterling 
Regional  Medical  Center: 

Haxtun  is  beginning  outlying 
clinics  in  Fleming  and  Crook  and 
has  hired  a nurse  practitioner  to 
staff  them.  Haxtun  has  just  lost  one 
physician  but  expects  another  to 
come  this  summer.  The  grant  will 
pay  many  of  the  recruitment  costs. 
Three  vehicles  have  been  pur- 
chased: a handicapped  van  for 
Haxtun,  one  for  moving  supplies 
between  the  two  communities,  and 


one  for  wellness  services.  Home 
health  and  wellness  services  are 
being  initiated. 

Weisbrod  Hospital  in  Eads/ 
Arkansas  Valley  Regional  Medical 
Center  in  La  Junta: 

The  two  hospitals  feel  that  the 
changes  in  their  relationship 
resulting  from  this  project  have 
been  nominal  - an  extension  of 
their  previous  relationship.  Eads 
sent  personnel  to  La  Junta  for  three 
weeks  of  training.  AVRMC  has 
established  a mobile  Women's 
Center.  Weisbrod  has  begun  two 
outreach  clinics  and  will  start  a 
third  in  September.  Teleradiology 
equipment  is  being  purchased. 
AVRMC  provided  work  processors 
to  Weisbrod. 

St.  Joseph's  Hospital  in  Del  Norte/ 
San  Luis  Valley  Regional  Medical 
Center  in  Alamosa: 

Eighteen  months  ago,  St. 
Joseph's  transferred  their  OB 
service  to  SLCRMC.  EMS  protocols 
are  being  worked  out.  St.  Joseph's 
operates  radiography  for  three 
facilities  and  has  expanded  lab 
capability  for  a wide  area,  includ- 
ing courier  pickup  from  doctors. 
SLVRMC  has  spent  some  money  on 
teleradiology  equipment. 

For  more  information  about 
this  project,  contact  Louise  Single- 
ton,  EACH/RPCH  Program  Direc- 
tor, at  692-2475. 


280 


Colorado  Medicine  for  August,  1993 


CMS  President  Leigh  Truitt , MD  (left)  and  CMS  Alliance  President  Pam 
Laman  (right)  congratulate  Mary  Hanson  (center)  on  her  installation  as 
President  of  the  American  Medical  Association  Alliance  in  Chicago. 


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Colorado  Medicine  for  August,  1993 


281 


FACT  SHEET 


Event:  “PLAYING  WITH  YOUR  FOOD”  by  HAROLD  MCGEE 

Lecture  and  luncheon  featuring  Dr.  Harold  McGee,  food  researcher  and  writer. 
“With  his  lively  and  learned  cookery  tomes,  researcher  Harold  McGee  brings 
experimental  flair  and  erudition  to  stovetop  mysteries"  (Smithsonian,  Dec. ’92) 
Books  published  are  On  Food  and  Cooking:  The  Science  and  Lore  of  the 
Kitchen,  and  The  Curious  Cook:  More  Kitchen  Science  and  Lore. 

“Dr.  McGee  has  put  to  good  use  his  natural  bent  for  tinkering,  a childlike  penchant 
for  playing  with  his  food,  and  an  inquisitive  mind  that  incessantly  asks  How?  Why? 
and  Is  that  so?” 


Sponsors:  COLORADO  MEDICAL  SOCIETY  ALLIANCE 

DENVER  MEDICAL  SOCIETY  ALLIANCE 


When:  MONDAY,  OCTOBER  25,  1993 


Where:  Lecture  11  a.m.-  12  noon  in  Ricketson’s  Auditorium 

Luncheon  immediately  following,  Denver  Museum 
of  Natural  History,  2001  Colorado  Blvd. 


To  Benefit:  HALL  OF  LIFE  - Purpose  is  to  raise  scholarship  funds  for  young  Colorado 

students  unable  to  afford  the  health  and  human  Dioiogy  classes  taught  by  ihe  Hai! 
of  Life  in  the  Denver  Museum  of  Natural  History  or  in  outreach  programs  in 
schools  throughout  the  state. 


Ticket  Options:  LECTURE  and  LUNCHEON  TICKET  IS  $40 

LECTURE  ONLY  IS  $30 

$30  is  tax  deductible 

Please  make  check  payable  to  Hall  of  Life  and  mail  to  6000  S.  Eaton  Lane, 

Littleton,  CO  80123 

Hall  of  Life:  The  mission  statement:  To  provide  to  people  of  all 

ages  innovative  exhibits  and  dynamic  educational 
programs  that  teach  how  the  body  functions,  that 
motivate  positive  health  choices,  and  that  emphasize 
the  role  of  personal  responsibility  in  matters  of 
health  and  physical  fitness. 

Last  year  almost  51,000  students  at  the  Museum  in  classes,  30,000  in  outreach, 

31,000  in  exhibit  tours  and  10,500  in  special  workshops  learned  about  health, 
and  human  biology  through  the  Hall  of  Life 

We  wish  to  thank:  The  Warwick  Hotel  and  0%  . „„ 

WAmericaWLst 

Airlines. 

WE  HAVEN'T  FORGOTTEN  IKE  MEANING  Of  RESPECT' 

Colorado  Medicine  for  August,  1993 


282 


Board  Highlights 


HIGHLIGHTS  OF  BOARD  OF  DIRECTORS  MEETING 


May  1 4,  1 993 

CMSA: 


AMA  Delegation: 


Medical  Student  Component: 


Board  of  Directors: 


Mrs.  Pam  Laman,  President,  reported  that  Mrs.  Patti  Brown  had  been 
elected  President-Elect.  The  name  change  to  CMS  Alliance  was  made 
official  at  the  House  of  Delegates  meeting  in  May.  Mrs.  Mary  Hanson  will 
be  installed  as  President  of  the  American  Medical  Association  Alliance  in 
June  at  the  AMAA  Annual  Meeting. 

Dr.  Mark  Levine  reported  that  the  Colorado  AMA  Delegates  and  Alternates 
would  be  attending  the  AMA  Annual  Meeting  and  a full  report  would  be 
given  at  the  July  BOD  meeting. 

Ms.  Maura  Lofaro  reported  that  six  medical  students  would  be  attending  the 
AMA  MSS  Annual  Meeting  in  June.  The  University  of  Colorado  Medical 
School  gave  $1200  to  help  fund  this  effort. 

The  Board  ratified  a motion  passed  by  the  Executive  Committee  that  dues 
monies  should  not  be  used  for  philanthropic  purposes  and  that  a fund  for 
member  donations  be  established  for  this  purpose. 

The  Board  also  ratified  a motion  which  called  for  a letter  to  be  sent  to  the 
Insurance  Commissioner  stating  the  concerns  CMS  has  with  the  proposed 
merger  of  the  CompreCare  and  TakeCare  insurance  companies,  citing 
issues  such  as  patient  care,  closing  out  physicians  and  loss  of  physician 
livelihood. 

The  Board  ratified  the  actions  of  the  CMS  Health  Care  Reform  Committee  in 
that  the  committee  should  examine  all  serious  health  care  reform  proposals, 
formulate  positions  and  suggest  alternatives  where  the  presented  plan  is 
contrary  to  the  interest  of  CMS  members  and  their  patients.  Additionally, 
the  CMS  health  care  reform  policy  would  serve  as  the  criteria  for  the 
Committee's  studies. 


Colorado  Medicine  for  August,  1993 


283 


lassified  Advertising 


Publication  of  any  advertisement  in  Colorado  Medicine  is  not  an  endorsement  by  the  Colorado  Medical  Society 
of  the  product  or  service.  Colorado  Medicine  magazine  is  the  official  journal  of  the  Colorado  Medical  Society,  and 
is  authorized  to  carry  General  Advertising. 


♦ PROFESSIONAL  OPPORTUNITIES 

INTERNAL  MEDICINE  - Colorado  Springs: 
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EMERGENT/URGENT  CARE  PHYSICIAN 
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AT  LAST!  Colorado  finally  has  a 
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PHYSICIANS,  (MD/DO)-  Part-time 
practice,  Denver,  Flight  surgeon,  Disaster 
& Occupational  medicine.  Visit  Exhibit  at 
CMS  '93  Conference.  Call  EDD  (303)772- 
61 85.  The  Air  National  Guard.  9/0293 

OCCUPATIONAL  MEDICINE-  Private 
practice,  3-4  days  per  week-  reasonable 
patient  load  - no  billing/no  hassles.  Good 
salary,  commensurate  with  experience. 
Long-term  opportunity  for  partnership  with 
right  person.  Call  Dr.  Shure  at  831-9393. 
3/0593 


♦ SITUATIONS  WANTED 

RN  EXPERIENCED  21  years  same  medical 
office  desires  challenging  medical  office 
position.  Very  flexible  S/E  Denver.  324- 
2927.  2/0793 

♦ PROPERTIES  FOR  SALE  OR  LEASE 

JEWELL  & WADSWORTH-  Retail/office 
space  for  lease  - excellent  exposure  - free 
standing  building -2000  square  feet  $1 375/ 
month.  Tenant  finish  $$  available.  Call 
Billy  Halax  973-1380  6/0593 

MAUI,  HAWAII.  Luxurious  2BR/2BA, 
2,100  sq.  ft.  condominium  in  Kaanapali 
Beach  Resort,  100  yards  from  beach. 
Everything's  new!  Pool,  Jacuzzi,  Sauna, 
Lighted  Tennis  Courts,  Maids.  On  16th 
fairway  of  the  Royal  Kaanapali  Golf  Club. 
Special  Spring/Summer  Rates.  Call  985- 
9531.  6/0393 

FOR  SALE:  Medical  Office  Building  located 
in  the  beautiful  Mtn.  community  of 
Woodland  Park,  Co.  18  Mi.  to  Colorado 
Springs  and  25  Mi.  to  Cripple  Creek.  Sale 
necessary  due  to  husband's  death.  For 
information  contact  Mrs.  R.  J.  Groeger — 
1 21 0 W.  Lorraine  Woodland  Park,  Co.  or 
call  (719)  687-2687.  6/0293 


CUT  OVERHEAD 

Share  office  space  in  beautiful  modern 
building  with  a great  view.  DTC  location. 
Full  or  part  time,  ideal  for  any  specialty 
except  pediatrics.  A fully  equipped 
surgical  suite  available  on  site.  This  is  an 
excellent  opportunity  to  enjoy  a modern 
well-equipped  facility  at  a reasonable 
cost.  Call  Lisa  - 773-3455  4/0793 


OFFICE  SPACE  FOR  LEASE-  newly 
decorated  suite  in  existing  OB/GYN  practice 
at  Mission  Trace  Shopping  Center  (near 
Wadsworth  & Hampden).  1 treatment  and 
1 consultation  room  just  right  for  FP  or 
other  primary  care.  High  traffec  area,  great 
potential,  call  Dr.  Robert  Konigsberg,  424- 
7877.  1/0893 


284 


Colorado  Medicine  for  August,  1993 


Classified 


MEDICALOFFICESPACE  ALREADY  BUILT 
OUT  AND  PAID  FOR.  Save  your  $$$$$'s. 
Greenwood  Village  location;  1 -1/2  blocks 
west  of  I-25/Belleview  interchange,  very 
easy  for  patients  to  find.  3,188  rentable 
square  feet.  Extensive  medical  finishes  and 
upgrades  throughout,  x-ray  machine, 
cabinets,  desks,  phone  system,  all  available 
for  purchase.  Property  managed  on-site- 
Available  for  immediate  occupancy. 
Contact  CB  Commercial  Fairbairn/Ogilvie 
(303)  799-1800. 

♦ EQUIPMENT  FOR  SALE  OR  LEASE 

PANASONIC  PHONE  SYSTEM-  Perfect  for 
small  medical  office,  PBX  line  auto  attended. 
$3000.00.  Call  465-2323.  2/0893 

BUY  DIRECT -LOCAL  MICK.  Custom 
Office  Furniture — Desks,  Credenzas, 
bookcases,  Files,  work  stations,  waiting 
room  seating,  etc.  Oak-cherry  & walnut. 
We  build  quality  custom  office  furniture  at 
a price  you  can  afford.  Mark  IV  Systems, 
I^c.  297-1 248.  8:00-4:30  M-F.  1 2/0293 

GE  Ultrasound  3200  with  MHZ  Vaginal 
Probe,  3.5  MHZ  Convex  Transducer. 
Excellent  condition.  Take  over  lease  at 
$881.41  for  13  months.  John  Hutto,  MD. 
(303)  425-0479.  Ask  for  Jerry.  1/0893 

♦ SERVICES 

DOCTORS-  Unsecured  loans  available  in 
any  amount  from  $5,000  to  $50,000  with 
yourgood  credit.  Easy  terms  and  good  interest 
rate.  Call  Marian  at  740-791 8.  1/0893 

LOOKING  FOR  QUALITY  HOME  HEALTH 
CARE?  Refer  your  patients  to  a non-profit, 
bonded  and  certified,  total,  affordable  home 
care  service.  Call  Betty  at  740-0024.  1/0893 

QUICK  CLAIM  ELECTRONIC  CLAIMS 
PROCESSORS,  HMO  PPO,  MEDICARE, 
MEDICAID  AND  PATIENTS  BILLING  (303) 
333-8666.  22/0393 

WE  B U Y MO RTAGATG  E N OTES-  Get  you r 
money  out- National  lenders  will  buy  notes 
from  $30,000  and  up.  Must  have  all 
deeds.Call  Marian  at  740-791 8.  1/0893 


HOME  MORTGAGE  LOANS 
LOW  DOC  PROGRAM  available  for 
physicians  and  other  health  professionals. 
Purchase  and  refinance.  Call  Milt,  a 
mortgage  banker  with  1 8 years  experience. 
753-6262.  12/1292 

INNOVATIONS  SHOULD  BE  PATENTED 

if  marketable.  For  more  information  call 
Brian  D.  Smith  of  Fields,  Lewis,  Pittenger  & 
Rost.  Colo's  leading  patent  law  firm.  Mr. 
Smith  specializes  in  the  medical  arts.  (303) 
758-8400.  12/1192 

RESIDENTIAL  REAL  ESTATE  SALES.  Dealing 
in  homes  valued  above  $250,000.  12  yrs. 
exper.  BS:  Real  Estate  and  Construction 
Mgmt-D.U.  MS:  Finance  & Tax  - C.U. 
Steven  Carter,  Pres.  Flatiron  RE  Serv. 
Denver/Boulder  (303)888-0521 


If  the  objective  is  financial  independence... 
there  is  another  way...  Outsourcing 
through  Clinic  Service  Corporation. 
Established  in  1974  simply  as  a billing 
service,  today  we  offer  Colorado's  most 
extensive  practice  management  package. 
Expandable,  CSC  systems  grow  to  meet 
your  demands.  For  more  information  and 
references  please  call  Yvette  Schrock  at 
777-9674. 

♦ MISCELLANEOUS 

EQUIPMENT  NEEDED  URGENTLY  for 

large  community  health  center  located  in 
Longmont.  Our  five-exam  room  facility 
will  soon  expand  to  1 2 exam  rooms  and  we 
are  looking  for  good  used  office  equipment 
and  exam  room  furnishings.  Call  to  discuss 
price/donations  with  Mark  Kissack  at  (800) 
388-4325.  6/0393 


Vice  President 
Medical  Services 

St.  Mary’s  Hospital  Medical  Center,  a highly 
respected  acute  care  facility  with  294  licensed  beds, 
is  beginning  the  search  for  a Vice  President  of 
Medical  Staff  Services. 

The  successful  candidate  will  be  a board-certified 
physician,  currently  licensed  (or  eligible)  to  practice 
in  the  State  of  Colorado,  with  a minimum  of  5 years 
experience  in  the  practice  of  medicine.  Experience 
in  hospital  administration  and/or  a position  of  pro- 
fessional leadership  strongly  preferred. 

Please  send  curriculum  vitae  to:  M.J.  Brown,  Ad- 
ministration, P.O.  Box  1628,  Grand  (unction,  CO 
81502-1628.  EOE. 

ST.  MARY'S  HOSPITAL 

The  Regional  Medical  Center 


Colorado  Medicine  for  August,  1993 


285 


Ruminations 


(def:  chewing  again  what  has  been  chewed  slightly  and  swallowed;  to  REFLECT) 


by  Bill  Pierson,  Managing  Editor 


Viet  Nam:  a correction 


I know  what  you  want  to 

say.  I am  surprised  you  haven't  said 
anything  yet.  It  is  possible,  I sup- 
pose, that  you  didn't  recognize  it 
when  you  saw  it,  but  now  you  don't 
want  to  cal  I attention  to  the  fact  that 
it  hit  you  rather  late  and  you  don't 
want  to  be  thought  of  as  slow. 

Sure,  it  isn't  very  important,  but 
that's  never  stopped  you  before.  I 
am  beginning  to  feel  rather  insecure 
when  I don't  get  a lot  of  phone  calls 
reminding  me  of  my  blunder,  sug- 
gesting ways  I might  have  better 
spent  my  misspent  youth. 

O.K!  I am  printing  a correction. 
In  Colorado  MedicineV ol.  90,  No. 7, 
pg.  240  (July,  1993),  a ruled  line 
between  the  name  "Viet  Nam"  and  a 
location  on  an  accompanying  map 
was  erroneously  drawn  to  Japan  in- 
stead of  Viet  Nam.  The  corrected 
copy  is  printed  above. 


Speaking  of  "misspent",  I have 
recently  reflected  at  length  on  my 
first  60  + years  of  youth  and  how,  at 
the  passing  of  Christmas,  1992,  I 
suddenly  grew  up  ...  I had  my  first 
known  experience  with  mental 
illness.  It  has  been  said  that  most  of 
us  (we  "normal"  workaday  people) 
suffer  some  degree  of  mental  illness 
any  day  of  the  week  but  we  just 
don't  know  it.  I suffered,  and  I knew 
it,  and  from  this  came  a better 
understanding  of  what  mental  illness 
really  can  be. 

You  see,  I quit  smoking;  I put 
down  my  pipe  for  good.  I soon 
became  depressed,  and  that  deepest, 
dark  depression  lasted  for  over  two 
months.  I couldn't  understand  what 
had  happened  to  me.  Suddenly,  most 
everything  in  a heretofore  bright, 
optimistic  life  was  drained  out.  I had 
nothing  to  look  forward  to;  every- 
thing was  behind  me. 

I was  absolutely  powerless  to  do 
anything  about  my  mind.  I couldn't 
get  myself  back  on  track,  no  matter 
how  many  times  I told  myself  there's 
everything  to  live  for  and  I've  done  a 
great  thing  by  quitting  tobacco. 

Finally  ! at  least  got  up  courage 
to  ask  my  wife,  a long-time  experi- 
enced and  successful  therapist.  She 
told  me  how  I had  caused  myself 
tremendous  imbalance  and  it  was 
going  to  take  my  mind  and  body  a 
while  to  adjust  to  the  absence  of  the 
habit.  She  added  "There  is  a bright 
note:  You  will  get  over  it."  It  took 
another  month  and  a half  before  I 
was  back  to  "normal".  She  ex- 
plained: When  I quit,  after  a 53-year 
habit  that  consumed  much  of  every 
day  of  my  life,  I felt  I had  killed  my 
best  friend.  I could  only  see  the  once 


warm,  comforting  companion  with 
the  seldom  disagreeable  pesonality, 
now  just  a body  lying  there  with  no 
being,  and  never  again  to  be  revived. 
And  I had  made  the  decision  to  put 
an  end  to  it. 

Sure,  I missed  the  tobacco,  but 
more  than  that  I missed  my  best 
friend,  the  one  I chose  to  do  away 
with.  As  I ruminate  I think  of  the 
many  very  happy  years  we  spent, 
always  together,  seldom  out  of  reach 
of  one-another.  Once  in  a while,  one 
of  us  would  wander  off  somehow 
and  get  misplaced,  but  not  for  very 
long.  We  had  a lot  of  friends  who 
recognized  each  of  us  and  got  us 
back  together. 

I understand  now  how  a person 
can  be  thrown  into  one  of  these 
deep,  lonely  depression  dungeons 
with  no  apparent  cause.  It  can 
happen  even  after  having  committed 
no  sin  or  crime  or,  as  in  my  case,  at 
a time  when  I should  have  been 
exceedingly  happy  because  I was 
able  to  kick  a 53  year  non-stop  habit. 

I have  an  understanding  of 
loneliness  brought  on  by  one's  acts 
or  sins  which  can't  be  reasoned 
aloud  or  shared  with  anyone  else.  All 
of  the  sadness,  the  remorse,  the 
blame,  the  self-immolation  remains 
inside,  and  the  cause  of  the  whole 
thing  is  as  "simple"  as  a little  chemi- 
cal imbalance.  Most  cases  of  this 
kind  of  depression  are  far  from 
simple;  psychiatrists,  psychologists 
and  therapists  have  to  work  so  very 
hard  to  find  a root  cause. 

It  hurt  for  a long  time,  but  I'm 
glad  I am  more  aware  and  under- 
standing of  mental  illness.  I am  so 
unbelievably  happy  that  I am  not  a 
victim  of  chronic  depression. 


286 


Colorado  Medicine  for  August,  1993 


ember,  1993  Volume  90,  Number  9 


GOING  THROUGH*  Anvmtanm  -cc  S.i  dent  beer  - «•  nngrp  wh«n  the  luw  olfccrs- 
r i.  p* fj  resident  h n i ri .»  cocked  Smi Iti  s -0;,*5  not  hit- i!nv«  p jii  a tf.ck  Oitribul- 
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man  n cr*"*’ni  S*fMM  yuk?syd&p.  The  re:-  - through,  and  r=  ur*.  hurt. 


HEALTH  SCIENCES  LIBRARY 
.UNIVERSITY  OF  MARYLAND 
BALTIMORE 

SEP  2 11893  STACKS 


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Are  we  teaching  our  children  that 
violence  is  the  answer? 

See  Page  3 / 2 


ast  Chance...  Our  Greatest  Challenge Page  295 

nber  is  Women  in  Medicine  Month Page  298 

ally  Indigent  Benefit  from  CMS  Efforts Page  303 

ase  for  Practice  Guidelines Page  320 


When  You  Slop  For 
Malpractice  Insurance, 
Low  Bid  Doesn’t  Always  Give 
You  The  Real  Bottom  Line 


Chances  are,  if  a Colorado  physician,  or  a medical  manager,  comparison  shops 
for  malpractice  insurance,  Copic  Insurance  Company  will  offer  the  best  price, 
when  all  of  the  discounts  and  dividends  are  sorted  out.  ♦♦♦  Even  so,  low  bid 
doesn’t  give  you  the  real  bottom  line.  If  responsiveness  to  policyholder  needs 
and  many -faceted  contributions  to  the  Colorado  physician  community  are 
factored  in,  Copic’s  out-  of-  state  competitors  can’t  even  come  close.  ♦♦♦  Besides, 
low  bid  could  carry  a very  high  price  if  - as  happened  a few  years  ago  - Copic’s 
competitors  drop  Colorado  like  a hot  potato  and  flee  the  state  when  the  going 
gets  rough,  or  when  the  process  server  drops  the  summons  or  subpoena. 

Copic’s  here  to  stay.  And,  our  damage  control  and  legal  defense  teams  are 
the  best  in  the  business. 

The  Copic  Bottom  Line. 

It’s  more  than  just  competitive  rates. 


Opic 


Copic  Insurance  Company 

PO.  Box  17540  • Denver,  CO  80217-0540  • (303)  779-0044  • 1-800-421-1834 


Colorado 

September,  1993 


Medicine 

Volume  90,  Number  9 


Cover  Story 

It'son television,  inthe news- 
papers, in  magazines,  in  elec- 
tronic games...  and  Dr.  Tho- 
mas Coleman  believes  it's 
time  its  purveyors  took  re- 
sponsibility for  itseffects.  See 
Page  312. 


Hn  This 

295  Our  last  chance...  Our  greatest  challenge 

Leigh  Truitt,  MD 
President,  Colorado  Medical  Society 

298  September  is  Women  in  Medicine  Month! 

Louise  L.  McDonald,  MD 
CMS  Board  of  Directors 


302 


University  of  Colorado  School  of  Medicine  Admissions 
Committee 

Leigh  Truitt,  MD,  CMS  President 


303  Golf  Money  Helps  Indigent 


Departments 


295  President's  Letter 
304  Health  System  Reform 
3Q6Health  Care  Financing 
308 Board  Highlights 
309Specialties 
31  0 Letters 

31  5 Health  Care  Definitions 
318Health  Department 
321  Medical  News 
324  New  Members 
328 Classified  Advertising 
330  Ruminations 


31 1 Understanding  Health  Care  Integration-Part  II 

Ted  Lewis,  MD,  Director  of  Medical  Education 
Penrose-St.  Francis  Hospital,  Colorado  Springs,  Colorado 

31  3 Entertainment  is  Killing  Us 

Thomas  H.  Coleman,  MD 
Denver,  Colorado 


316  A Look  Back  Looks  Ahead 

George  O.  Thomasson,  MD 
Denver,  Colorado 


320  Why  Clinical  Practice  Guidelines? 

by  Ted  Lewis,  MD 
Colorado  Springs,  Colorado 


Colorado  Medical  Society 


COLORADO  MEDICAL  SOCIETY 
OFFICERS,  BOARD  MEMBERS  and  AMA  DELEGATES 


1992/1993  Officers 
Leigh  Truitt,  M.D. 

President 

Wm.  Carl  Bailey,  MD 

President-elect 
Terrance  J.  Sullivan,  M.D. 

Treasurer 

Stuart  O.  Silverberg,  M.D. 

Speaker  of  the  House 

David  C.  Martz,  M.D. 

Vice-speaker  of  the  House 

Sandra  L.  Maloney 

Secretary/Executive  Director 

Harrison  G.  Butler,  III,  M.D. 

(Immediate  Past  President) 


Board  of  Directors 

Board  of  Directors 

Thomas  j.  Allen,  MD 

Susan  A.  Sherman,  MD 

Stephen  G.  Batuello,  MD 

Gary  D.  VanderArk,  MD 

John  O.  Cletcher,  Jr.,  MD 

Denis  J.  Winder,  MD 

Donald  G.  Eckhoff,  MD 
John  E.  Ell  iff,  MD 

M.  Robert  Yakely,  MD 

Jonathan  C.  Feeney,  MD 
David  C.  S.  Franklin,  MD 

AMA  Delegates 

Joel  M.  Karlin,  MD 

M.  Ray  Painter,  Jr.,  MD 

George  M.  Kreye,  MD 

Richert  E.  Quinn,  Jr.,  MD 

Muryl  L.  Laman,  MD 
Ted  T.  Lewis,  MD 

Mark  A.  Levine,  MD 

Theresa  A.  Scholz 
Louise  L.  McDonald,  MD 

Alternate  Delegates 

Robert  A.  Nathan,  MD 

Robert  D.  McCartney,  MD 

Kenneth  M.  Olds,  MD 

Robert  M.  Bogin,  MD 

Lothar  K.  Roller,  MD 
David  Shander,  MD 

Joel  M.  Karlin,  MD 

W.  George  Shanks,  MD 

Robert  R.  Montgomery, 

Legal  Counse 

COLORADO  MEDICAL  SOCIETY  STAFF 


Executive  Office 

Sandra  L.  Maloney,  Executive  Director 
Mary  Lee  Johnston,  Executive  Admin.  Asst. 
Nancy  L.  Deter,  Manager,  Accounting 

Western  Slope  Office 

Dolores  M.  Bennett,  Executive  Secretary 

Division  of  Membership  Information  Services 

Timothy  H.  Roberts,  Director 
Diane  L.  LeHew,  Manager,  Support  Services 
Debra  M.  (ones,  Membership  Coordinator 
Beth  M.  Crusha,  Administrative  Assistant 


Division  of  Health  Care  Policy 

Ellen  J.  Stein,  Director 

Marilyn  P.  Barton,  Program  Manager 

Lynn  R.  Livingston,  Administrative  Assistant 

Division  of  Health  Care  Financing 

Edie  K.  Register,  Director 
Marijo  M.  Parkin,  Program  Manager 

Division  of  Government  Relations 

Sue  Ellen  Quam,  Director 

Lorraine  L.  Koehn,  Program  Manager/Lobbyist 

K.  Suzanne  Hamilton,  Administrative  Assistant 


Division  of  Professional  Services 

Sandra  M.  Finney,  Director 
Lorraine  K.  Heth,  Program  Manager 
Kirsten  E.  Regalado,  Secretary 


Division  of  Communications 

William  S.  Pierson,  Director 

Michael  P.  Thompson,  Communications  Mgr. 

Gil  Maestas  II,  Communications  Specialist 


COLORADO  MEDICINE  (ISSN-01 99-7343)  is  published  monthly  as  the  official  journal  of  the  Colorado  Medical  Society,  7800  E.  Dorado  PI.,  Englewood,  CO  80111.  Telephone  (303)  779-5455.  Outside 
Denver  area,  call  1 -800-654-5653.  Secona  Class  postage  paid  at  Englewood,  Colorado,  and  at  additional  mailing  offices.  POSTMASTER,  sena  address  changes  to  COLORADO  MEDICINE,  P.  O.  BOX 
1 7550,  Denver,  CO  8021  7-0550.  Address  all  correspondence  relating  to  subscriptions,  advertising  or  address  changes,  manuscripts,  organizational  and  other  news  items  regarding  the  editorial  content 
to  the  editorial  and  business  office.  Subscriptions  are  available  for  $30  per  year,  paid  in  advance. 

COLORADO  MEDICINE  magazine  is  the  official  journal  of  the  Colorado  Medical  Society,  but  as  such  is  also  authorized  to  carry  general  advertising.  Publication  of  any  advertisement  in  COLORADO 
MEDICINE  does  not  imply  an  endorsement  or  sponsorship  by  the  Colorado  Medical  Society  of  the  product  or  service  advertised.  Published  articles  represent  opinions  of  the  authors  and  do  not  necessarily 
reflect  the  official  policy  of  the  Colorado  Medical  Society  unless  clearly  specified. 

Sandra  L.  Maloney,  Executive  Editor;  William  S.  Pierson,  Managing  Editor;  Michael  Thompson,  Asst.  Managing  Editor,  Gil  Maestas,  II,  Communications  Specialist 


Member,  Colorado  Press  Association, 


Member,  Colorado  Broadcasters  Association 


292 


Colorado  Medicine  for  September,  1993 


MEDICAL  OFFICE  SPACE  FOR  LEASE 

If  you’re  thinking  about  relocating  and  you  want  to  be  close  to  the 
downtown  area,  Midtown  Medical  Center  is  for  you.  The  1993 
winner  of  the  BOM  A (Building  Owners  and  Managers 
Association)  Medical  Building  of  the  Year  award,  Midtown 
Medical  Center  has  two  buildings  from  which  you  can  select 
prime  office  space. 

Features  include: 

1.  conveniently  located  near  Saint  Joseph  Hospital. 
Presbyterian/St.  Luke’s,  Children’s  and  Mercy 

2.  pharmacy  on  first  floor 

3.  hospital-based  outpatient  diagnostic  center  on  premises 

4.  on-site  exercise  club 

5.  recently  renovated  common  areas,  fire  alarm  and  fire  sprinklers 

6.  on-site  security  nights  and  weekends 

7.  full  service  lease  with  on-site  management  and  maintenance 

8.  convenient  parking  with  ADA  accessibility 

Call  866-8181  today  for  more  information  or  to  schedule  an 
appointment.  NO  BROKERS  PLEASE. 

Midtown  Medical  Center 
2005  Franklin  Street 
866-8181 


Colorado  Medicine  for  September,  1993 


293 


Computer  Talk 

Medical  Practice  Automation  Issues  & Information 

a service  of 

/MicroAge 

8620  Wolff  Court  - Westminster,  CO  80030  (303)  427-2121 


Have  You  Checked  Your  Vendor's  Vital  Signs? 


Dr.  Williams  and  his  office 
manager,  Mary*,  spent  more  than  five 
months  searching  for  the  best  com- 
puter system  for  his  busy  family 
practice.  In  all,  they  looked  at  twelve 
vendors,  survived  as  many  demon- 
strations, and  finally  narrowed  their 
search  to  two.  Both  provided  Dr. 
Williams  with  excellent  references, 
some  of  whom  he  knew  personally. 

In  the  end  Dr.  Williams  and 
Mary  decided  to  go  with  the  most 
popular  of  the  two  vendors.  They  felt 
reasonably  secure  in  their  decision 
because  this  vendor  had  the  most 
references,  had  been  around  for 
several  years,  and  was  highly  visible. 

The  new  system  was  soon 
installed  and  in  less  than  two  months 
they  were  up  and  running. 

In  less  than  four,  the  vendor 
was  out  of  business. 

The  following  month  they 
received  a newsletter  from  Medicare 
informing  providers  of  a required 
change  in  the  HCFA- 1 500  form.  Dr. 
Williams'  office  staff  dealt  with  this 
problem  by  inserting  Medicare  forms 
into  the  trusty  old  typewriter  and 
typing  in  the  new  information 
manually.  Unfortunately,  electronic 
billing  could  no  longer  be  used. 

Next,  the  printer  stopped 
functioning.  An  experienced  techni- 
cian from  a reputable  computer  firm 
was  located  and  spent  six  hours 
working  on  the  system.  Finally,  he 
explained  to  Dr.  Williams  that  the 
bankrupt  vendor  had  used  many 
"proprietary"  protocols,  which  meant 
only  they  knew  how  to  solve  this 
problem.  The  bill:  $495.  A second 
opinion  cost  Dr.  Williams  $570. 

It  was  just  about  this  time 
that  Dr.  Williams  was  contacted  by  an 


ex-employee  of  the  expired  vendor, 
who  had  gone  into  business  for 
himself,  supporting  orphaned  users 
like  Dr.  Williams.  "Ted",  apparently 
in  great  demand,  scheduled  an 
appointment  for  the  following  week. 
Until  then,  no  billing  could  occur. 

Less  than  ten  minutes  after 
Ted's  arrival,  the  printer  was  running 
perfectly.  For  this  he  received  his 
standard  fee  of  $500.  But  he  was 
unable  to  help  with  the  electronic 
billing  program  because  not  even  Ted 
had  access  to  the  software  "source 
code." 

Over  the  next  year,  Ted 
earned  more  than  $4,000  from  Dr. 
Williams'  office  for  calls  that  would 
ordinarily  have  been  covered  under 
his  original  support  contract,  now 
worthless.  Dr.  Williams  could  not 
help  but  notice  that  Ted  was  now 
driving  a nicer  car  than  he  was. 

Fed  up  with  ever-increasing 
computer  problems.  Dr.  Williams 
decided  to  take  Mary's  advice  to  sell 
the  system  and  switch  to  the  vendor 
who  had  originally  placed  second. 

After  a fruitless  search  for  a 
buyer.  Dr.  Williams  finally  paid  an 
electronic  equipment  junk  dealer  $160 
to  remove  almost  every  piece  of 
equipment  he  had  purchased  from  the 
extremely  popular  vendor  he  and 
Mary  had  so  carefully  selected. 

When  the  smoke  cleared.  Dr. 
Williams  had  spent  more  than 
$60,000  for  two  computers,  lost  an 
unknown  number  of  patients  tired  of 
hearing  of  "computer  problems",  and 
replaced  two  employees,  frustrated 
beyond  their  salary  level.  In  addition, 
thousands  of  dollars  in  cash  flow  were 
lost  due  to  billing  delays. 

Later,  Dr.  Williams  learned 


that  if  he  had  only  done  some  prudent 
background  checking,  he  would  have 
discovered  that  the  popular  vendor 
struggled  with  a mountain  of  debt, 
several  pending  lawsuits  and  a shaky 
credit  rating.  It  would  have  been  like 
providing  the  Titanic  with  radar. 

Here  are  some  steps  you  can 
take  that  can  help  you  avoid  Dr. 
Williams'  nightmare: 

1.  Ask  the  vendor  to  supply  you 
with  their  financials.  Many 
privately  held  companies  do  not 
publish  financials,  but  that's  okay. 
Ask  for  the  phone  number  of  their 
CPA.  If  they  don't  comply,  thank 
them  and  move  on. 

2.  Have  your  attorney  or  accoun- 
tant acquire  a Dun  & Brad- 
street  ("D&B")  report  and  a 
TRW  credit  report.  If  you  got 
your  vendor's  accountant's  phone 
number,  ask  your  attorney  or 
accountant  to  call  and  ask  some 
pertinent  questions. 

3.  Have  your  attorney  do  a 
pending  litigation  search 
through  Prentice  Hall  Legal  & 
Financial  Service  or  Equifax. 

Even  a single  lawsuit,  if  it's  large 
enough,  can  put  an  unbalanced 
company  out  of  business. 

4.  Examine  the  company's  history 
of  complaints  at  the  Better 
Business  Bureau,  the  Department 
of  Consumer  & Regulatory 
Affairs  and  the  Attorney  General's 
office.  Is  there  a long  list  of 
unhappy  customers?  Do  you 
want  to  be  on  it? 

Take  the  time  now  to  check 
your  vendor's  vital  signs,  no 
matter  how  well-established  they 
seem.  Don't  put  yourself  in  a 
position  to  be  sorry  you  didn't. 


Not  actual  persons,  but  a compilation. 


Photo  by  Rocky  Mountain  News 


Leigh  Truitt,  MD 
President,  1992-1993 


President's 


L 


This  is  my  last  President's  Letter 
to  you.  During  the  last  year  I have 
encouraged  you  to  assume  a 
leadership  role  in  the  restructuring 
of  health  care.  Our  opportunities  to 
practice  medicine  are  increasingly 
subject  to  the  administrative  actions 
of  hospitals,  insurers,  preferred 
provider  organizations  (PPOs),  health 
maintenance  organizations  (HMOs), 
and  other  non-physician  directed 
organizations.  1 have  been  aware  of 
many  instances  of  selective  con- 
tracting, termination  of  physicians 
from  managed  care  panels  for 
"business"  reasons,  physician 
profiling  that  does  not  appropriately 
reflect  severity  of  patient  mix  and 
scope  of  practice,  and  other  ex- 
amples of  economic  credential ing. 

Many  of  you  have  told  me  that 
the  independent  practice  of  medi- 
cine can  be  the  most  cost  effective, 
highest  quality  care  in  the  world. 
However,  we  must  demonstrate  our 
worth!  I now  call  on  you  to  take  up 
the  challenge  and  prove  that  we  can 
provide  more  value  in  health  care 
than  any  insurer,  hospital  system, 
PPO,  or  HMO.  In  the  1930s, 
physicians  organized  some  of  the 
first  health  insurance  plans  in  this 
country  to  insure  that  everyone 
could  afford  health  care. 

The  program's  benefits  were  sub- 
stantial, but  the  premiums  were 
initially  token  amounts,  as  were  the 
payments  to  physicians  and  hospi- 
tals. The  hospitals  granted  Blue 
Cross  significant  discounts  because 
of  the  program's  charitable  struc- 
ture. It  was  a most  commendable 
project  to  provide  access  to  needed 
medical  care  for  the  poor,  initiated 


and  supported  by  the  medical 
profession  (fearful  of  state  medi- 
cine) and  the  hospitals.1 

Acting  through  the  Board  of 
Directors  of  the  Colorado  Medical 
Society,  we  intend  to  present  a 
resolution  to  the  House  of  Del- 
egates to  study  the  feasibility  of 
sponsoring  a statewide  independent 
practice  association  (IRA)  to  be 
the  physician  provider  network  for 
an  HMO/PPO.  We  could  conceiv- 
ably create  this  HMO/PPO  ourselves 
as  the  Connecticut  State  Medical 
Society  successfully  has  done.  More 
likely,  we  will  establish  a joint 
venture  or  partnership  with  an 
established  insurer  or  HMO  in  order 
to  acquire  the  necessary  business 
systems. 

This  IPA  will  be  separate  from 
but  sponsored  and  endorsed  by  the 
Colorado  Medical  Society,  similar  to 
our  relationship  with  COPIC.  All 
membership,  utilization  review, 
quality  assurance,  and  reimburse- 
ment decisions  will  be  under  the 
control  of  physicians  who  are 
members  of  the  IPA.  All  members 
of  the  Colorado  Medical  Society  will 
be  eligible  to  join  the  IPA,  but 
participation  will  require  a member- 
ship fee,  credentialing  in  regard  to 
malpractice  and  disciplinary  experi- 
ence, and  continuing  review  of 
utilization  and  quality  of  care. 

We  would  like  to  believe  that  we 
can  establish  utilization  review 
mechanisms  that  will  result  in  very 
low  costs  of  care  without  resorting  to 
capitation,  gate  keepers,  and  other 
similar  mechanisms  of  cost  control. 
To  do  so  may  be  impossible  and 


Our  last  chance  ... 
our  greatest  challenge 


continued  on  following  page. . . 


Colorado  Medicine  for  September,  1993 


295 


President's  Letter 


would  in  any  event  require  the  full 
dedication  of  both  the  physicians 
and  patients.  We  must  accept  the 
realities  of  the  market  place  and 
understand  that  there  is  no  room  for 
another  "me  too"  entity  priced  above 
the  lowest.  With  current  techniques 
of  data  management,  there  is 
evidence  that  IPA  model  HMO's  can 
be  cost  competitive  with  staff  and 
group  model  HMOs.2 

If  the  House  of  Delegates 
approves  this  resolution,  we  will 
begin  a feasibility  study  to  create  this 
IPA.  You  must  not  look  at  this  as  an 
opportunity  to  increase  reimburse- 


ment or  to  continue  to  practice 
medicine  as  an  isolated  economic 
entity  whose  actions  carry  no 
consequences.  We  must  seek  to 
become  the  low  cost,  high  quality 
provider  of  health  care  to  the  citizens 
of  Colorado.  There  is  no  other 
market  position  worth  pursuing.  I 
view  this  as  a base  to  your  practice 
that  no  one  other  than  your  peers 
can  take  away  — not  the  icing  on  the 
cake. 

If  ColoradoCare  or  some  other 
health  care  reform  proposal  is 
enacted  in  the  next  year,  virtually 
everyone  in  Colorado  will  have 
some  form  of  health  insurance. 


Therefore,  at  this  time  there  is  an 
opportunity  to  enter  into  a partner- 
ship with  the  people  of  Colorado  to 
assure  that  the  costs  of  this  insurance 
will  be  affordable.  We  need  to  be  in 
a position  to  demonstrate  that  we 
have  made  our  best  efforts  to  make 
freedom  of  choice  affordable. 

References: 

1 Edward  Palmer,  "Original  Intent  of  Blues 
Plans,"  Letter  to  the  Editor,  Health  Affairs, 
Summer,  1993,  p.  219. 

2 Paul  J.  Kenkel,  "IPAs  can  be  as  efficient  as 
staff  HMOs  — study,"  Modern  Healthcare, 
July  12,  1993,  p.  16. 


BE  AN  AIR  FORCE 
PHYSICIAN. 

Become  the  dedicated  physician  you 
want  to  be  while  serving  your  country  in 
today’s  Air  Force.  Discover  the  tremen- 
dous benefits  of  Air  Force  medicine.  Talk 
to  an  Air  Force  medical  program  manag- 
er about  the  quality  lifestyle  and  benefits 
you  enjoy  as  an  Air  Force  professional, 
along  with: 

• 30  days  vacation  with  pay  per  year 

• Dedicated,  professional  staff 

• Non-contributing  retirement  plan  if 
qualified 

Today’s  Air  Force  offers  the  medical  envi- 
ronment you  seek.  Find  out  how  to  quali- 
fy. Call  To||  Free  uSAF  Health  Professions 
1-800-423-USAF 


296 


Colorado  Medicine  for  September,  1993 


FACT  SHEET 


Event:  “PLAYING  WITH  YOUR  FOOD”  by  HAROLD  MCGEE 

Lecture  and  luncheon  featuring  Dr.  Harold  McGee,  food  researcher  and  writer. 
“With  his  lively  and  learned  cookery  tomes,  researcher  Harold  McGee  brings 
experimental  flair  and  erudition  to  stovetop  mysteries"  (Smithsonian,  Dec. ’92) 
Books  published  are  On  Food  and  Cooking:  The  Science  and  Lore  of  the 
Kitchen,  and  The  Curious  Cook:  More  Kitchen  Science  and  Lore. 

“Dr.  McGee  has  put  to  good  use  his  natural  bent  for  tinkering,  a childlike  penchant 
for  playing  with  his  food,  and  an  inquisitive  mind  that  incessantly  asks  How?  Why? 
and  Is  that  so?” 


Sponsors:  COLORADO  MEDICAL  SOCIETY  ALLIANCE 

DENVER  MEDICAL  SOCIETY  ALLIANCE 

When:  MONDAY,  OCTOBER  25,  1993 


Where:  Lecture  11  a.m.-  12  noon  in  Ricketson’s  Auditorium 

Luncheon  immediately  following,  Denver  Museum 
of  Natural  History,  2001  Colorado  Blvd. 


To  Benefit:  HALL  OF  LIFE  - Purpose  is  to  raise  scholarship  funds  for  young  Colorado 

students  unable  to  afford  the  health  and  human  oioiogy  ciasses  taught  by  the  Hail 
of  Life  in  the  Denver  Museum  of  Natural  History  or  in  outreach  programs  in 
schools  throughout  the  state. 


Ticket  Options:  LECTURE  and  LUNCHEON  TICKET  IS  $40 

LECTURE  ONLY  IS  $30 

$30  is  tax  deductible 

Please  make  check  payable  to  Hall  of  Life  and  mail  to  6000  S.  Eaton  Lane, 
Littleton,  CO  80123 

Hall  of  Life:  The  mission  statement:  To  provide  to  people  of  all 

ages  innovative  exhibits  and  dynamic  educational 
programs  that  teach  how  the  body  functions,  that 
motivate  positive  health  choices,  and  that  emphasize 
the  role  of  personal  responsibility  in  matters  of 
health  and  physical  fitness. 

Last  year  almost  51,000  students  at  the  Museum  in  classes,  30,000  in  outreach, 
31,000  in  exhibit  tours  and  10,500  in  special  workshops  learned  about  health, 
and  human  biology  through  the  Hall  of  Life 

We  wish  to  thank:  The  Warwick  Hotel  and 

Airlines. 

WE  HAVENT  FORGOTTEN  THE  MEANING  OF  RESPECT' 


^America  Wfest 


Colorado  Medicine  for  September,  1993 


297 


eptember  is 

Women  in  Medicine  Month! 


Women  Physicians:  Are  They  Taking  Over? 


Louise  McDonald,  MD,  Chair 
CMS  Women  in  Medicine 
Section 


The  AMA  has  designated  September 
as  Women  in  Medicine  Month.  This 
gives  one  pause.  There  seems  to  be  a 
lot  of  hoopla  about  women  in 
medicine  these  days.  There  are 
Women  in  Medicine  Sections, 
Women  in  Medicine  Committees,  an 
AMA  Advisory  Panel  on  Women  in 
Medicine.  There  are  more  women 
physicians  in  the  CMS  House  of 
Delegates  and  even  a couple  of 
women  on  the  CMS  Board  of 
Directors.  Women  doctors  are 
speaking  up,  demanding  action, 
asking  for  leadership  positions  in 
their  group  practices,  on  medical 
staffs,  and  in  organized  medicine. 
Now  they  even  have  their  own 
Month!  Why  all  this  attention  to 
women  in  medicine?  Are  they  taking 
over? 

Last  year  several  hundred 
physicians  and  scientists  — mostly 
women  — met  in  Bethesda  to 
discuss  obstacles  to  women's  full 
participation  in  the  biomedical 
sciences.  Antonia  Novella,  MD,  this 
country's  first  woman  and  first 
Hispanic  Surgeon  General,  told  the 
attendees  that  "There  will  be  a day 
when  the  descriptors  of  what  I am 
will  no  longer  be  used  because  there 
will  be  so  many  minorities  and 
women  being  Surgeon  General  that 
it  will  be  obsolete  to  mention  that  I 
am  the  first,  and  I want  to  be  around 
when  that  day  comes." 

Times  are  indeed  changing.  Now 
just  a year  later  another  minority 
woman  physician  is  being  consid- 
ered for  Surgeon  General.  In  1970, 
25,400  out  of  334,000  total  physi- 


cians in  the  United  States  were 
female.  In  1 990,  there  were  61  5,000 
physicians  in  the  United  States  and 
1 04,000  were  female  — an  increase 
of  over  300%!  The  number  of 
women  physicians  nearly  qua- 
drupled in  20  years,  and  it  is  pro- 
jected to  top  30%  of  the  U.S. 
physician  population  by  the  year 
201 0.  The  degree  to  which  orga- 
nized medicine  attracts  women 
physicians  during  the  next  decade 
may  determine  its  effectiveness  and 
credibility  — and  even  its  survival. 

Women  now  comprise  about 
40%  of  students  enrolled  in  Ameri- 
can medical  schools  and  almost  30% 
of  all  residents.  More  than  half  of 
women  residents  are  training  in 
primary  care,  and  the  same  seven 
specialties  which  drew  the  most 
women  in  1 970  draw  them  now: 
internal  medicine,  pediatrics, 
general/family  practice,  psychiatry, 
ob/gyn,  anesthesiology  and  pathol- 
ogy. Women  are  three  times  as  likely 
as  men  to  be  pediatricians  and  less 
than  half  as  likely  to  be  surgeons. 
Why  do  women  turn  to  internal 
medicine  and  pediatrics  instead  of 
orthopedics  or  neurosurgery?  Some 
claim  that  bias  exists  against  women 
by  male  gatekeepers  of  the  "high 
prestige"  specialties.  On  the  other 
hand,  women  are  less  inclined  to 
apply  for  very  long  residencies;  they 
want  closer  and  more  enduring 
relationships  with  patients  and  more 
manageable  hours;  and  they  lack 
role  models  in  many  specialties. 
Ironically,  however,  health  care 
reform's  emphasis  on  preventive  and 


298 


Colorado  Medicine  for  September,  1993 


"Women  doctors  are  speaking  up,  demanding  action,  asking  for 
leadership  positions  in  their  group  practices,  on  medical  staffs, 
and  in  organized  medicine 


primary  care  may  hand  women 
physicians  in  primary  care  specialties 
a more  important  and  prestigious 
role  than  they  ever  played  before. 

Since  1 970,  the  number  of 
women  in  office-based  practice  has 
increased  almost  fivefold,  but  only 
one  quarter  of  them  work  in  group 
practices  of  three  or  more  physi- 
cians. Women  doctors  are  twice  as 
likely  as  men  to  be  in  employed 
salaried  positions.  They  earn  about 
two-thirds  of  the  male  mean  annual 
net  income,  although  the  growth  rate 
of  income  for  females  has  surpassed 
that  of  males  during  the  last  1 0 years. 

In  academic  medicine  the 
percentage  of  women  medical 
school  graduates  joining  medical 
school  faculties  has  been  consis- 
tently higher  than  that  of  men. 
However,  women's  accession  to 
senior  faculty  positions  has  not  kept 
pace  with  their  increasing  represen- 
tation on  the  faculties.  In  1 99  I , only 
9%  of  them  were  full  professors 
compared  to  32%  of  the  men.  There 
were  no  female  medical  school 
deans. 

75%  of  women  physicians  are 
married,  in  contrast  to  the  national 
average  of  90%  of  female  non- 
physicians and  90%  of  male  physi- 
cians. Among  physicians  who  are 
married,  90%  of  the  men  and  85%  of 
the  women  have  children.  Most  male 
physicians  do  not  change  their 
career  plans  or  behaviors  because  of 
family  responsibilities,  but  almost 
half  of  female  physicians  do. 

What  do  women  in  medicine 
want  that's  different  from  what  their 
male  colleagues  want?  The  answer  is 
"absolutely  nothing".  They  want  the 
same  access  to  educational,  resi- 


dency, and  practice  opportunities. 

It's  not  a question  of  "taking  over", 
but  they  also  want  equal  leadership 
opportunities. 

Isn't  this  happening  already? 
Aren't  they  getting  there?  No,  even 
while  the  number  of  women  in 
medicine  continues  to  increase, 
many  barriers  still  exist.  Women  still 
report  sexual  discrimination  and 
harassment  and  gender-based 
stereotyping,  especially  in  medical 
school  and  residency  training,  and  in 
the  procedure-oriented  specialties. 

They  are  still  subject  to  sexist 
slurs  and  unwanted  sexual  advances. 
Juggling  professional  and  family 
responsibilities  is  still  more  difficult 
for  women  than  for  men.  Society 
now  encourages  women  to  get  an 
education,  work  hard,  enter  a 
profession,  pursue  a career.  At  the 
same  time,  society  also  expects 
women  to  tend  to  their  traditional 
roles  as  wives  and  mothers.  Even  if 
these  expectations  ever  change, 
biology  probably  will  not.  Women 
will  always  bear  and  nurse  children 
and  cherish  their  ability  to  do  so.  But 
these  multiple  roles  do  create 
conflicts  that  inhibit  many  women 
from  devoting  as  much  time  to 
medical  practice  and  practice-related 
activities  as  do  their  male  counter- 
parts. 

In  the  future,  household  tasks 
and  parental  duties  may  lose  their 
sex  orientation  and  women  can  be 
physicians,  wives,  and  mothers  just 
men  are  physicians,  husbands  and 
fathers.  But  that  may  never  happen. 
That's  why  women  physicians  are 
concerned  about  appropriate 
parental  leave  policies.  A large 
number  of  training  institutions  and 


The  American  Medical  Association's 
Women  in  Medicine  Section  is  using 
these  buttons  to  promote  empower- 
ment of  women  physicians. 


Colorado  Medicine  for  September,  1993 


299 


Women  in  Medicine  Month 


continued... 


" Women  still  report  sexual 
discrimination  and 
harassment  and  gender- 
based  stereotyping , 
especially  in  medical 
school  and  residency 
training , and  in  the 
procedure-oriented 
specialties 


medical  practices  remain  unprepared 
to  accommodate  the  needs  of 
pregnant  physicians  or  to  resolve  the 
scheduling  issues  encountered  when 
physicians  take  parental  leave. 

Women  physicians  also  worry 
about  adequate  quality  child  care. 
They  want  more  teaching  and 
community  hospitals  to  provide  child 
care  options.  They  want  residency 
programs  to  offer  more  part-time  or 
shared  residency  positions,  and  they 
want  more  flexible  practice  arrange- 
ments such  as  part-time  positions, 
flexible  hours  or  job  splitting/sharing 
during  child  raising  years.  Arnold 
Reiman  wrote  in  the  New  England 
Journal  of  Medicine  in  1989,  "A 
changing  younger  profession  more 
broadly  representative  of  American 
Society,  with  more  moderate  income 
expectations  and  a greater  commit- 
ment to  the  primary  care  specialties, 
will  be  in  a better  position  to  meet 
the  needs  for  health  care  in  the  next 
century."  The  advent  of  more 
women  in  medicine  is  helping  to 
create  that  future,  and  the  systems  in 
place  for  training  and  utilizing  their 
skills  must  adjust  to  the  typical  life 
cycles  that  women  follow. 

Women  in  medicine  are  also 
concerned  about  the  same  issues  that 
men  ponder:  health  care  reform, 
government  regulations,  malpractice 
costs,  etc.,  but  women  physicians 
feel  they  care  more  than  men  about 
women's  health,  family  violence, 
and  reproductive  rights. 

When  you  think  about  the  above 
numbers,  it's  obvious  that  county, 
state,  and  national  specialty  societ- 
ies, and  the  AMA  must  reach  out  to 
women  physicians  so  that  organized 
medicine  doesn't  lose  one  of  its  most 


valuable  potential  resources  for 
participation,  leadership,  and 
financial  support. 

At  the  same  Bethesda  meeting 
last  year,  wild  applause  greeted  Dr. 
Novello  when  she  affirmed:  "It  is  the 
time  for  a little  rage  that,  in  women, 
it's  called  PMS,  and,  in  men,  it's 
called  healthy  aggression  and 
initiative."  Women  in  Medicine 
Month  isn't  about  taking  over,  it's 
only  about  equality,  about  the  day 
when  all  physicians  are  judged  not 
on  gender,  race,  ethnic  background, 
sexual  orientation  or  anything  other 
than  their  competence  and  dedica- 
tion to  the  profession. 


PHYSICIAN/  5 
CLINIC 
DIRECTOR 

Health  Network  of  Colorado  Springs, 
Inc.  has  an  opening  for  a physician  to 
assume  the  position  of  Clinic  Director 
for  an  adult  outpatient  after  hours 
operation.  The  physician  would  be 
responsible  for  medical  policy  and 
will  coordinate  the  medical  activities  of 
other  participating  physicians.  Candi- 
date should  have  current  Colorado 
license  and  be  Board-certified  or 
board-eligible  in  family  practice  or 
internal  medicine.  This  position  rep- 
resents a full-time  commitment  and 
offers  a competitive  salary  and  an 
incentive  program.  Interested  candi- 
dates should  send/fax  their  resume  to: 

Medical  Director 
Health  Network  of  Colorado 
Springs,  Inc. 

555  East  Pikes  Peak,  Suite  108 
Colorado  Springs,  CO  80903 
FAX  #719-475-5004 

EOE  E 


300 


Colorado  Medicine  for  September,  1993 


When 

You’re 

Covered, 

You’re 

Covered 


Protection  this  good  comes  from  those  who 
know  you  best.  Who  are  there  to  look  out  for 
your  best  interests.  Who  understand  your 
special  needs. 

That’s  why  Colorado  physicians  and 
surgeons  can  put  their  trust  in  The  Doctors’ 
Company.  We’re  the  largest  doctor-owned, 
doctor- managed  professional  liability  insurer 
with  over  16,800  member-doctors 
nationwide.  And  we’ve  been  helping  good 
doctors  practice  better  medicine  since  1976. 

We  are  rated  “A  + ” (Superior)  by  A.M.  Best 
Company,  independent  analysts. 

The  Doctors’  Company  and  our  local 
Colorado  agents  provide  a level  of  service  that 
promises  to  ensure  your  peace  of  mind. 

If  you’re  not  already  covered  by  The  Doctors’ 
Company,  call  today. 

Endorsed  by  Denver  Medical  Society. 


The  Doctors  Company 


Professional  Liability  Insurance 


For  more  information  call 

The  Doctors'  Company— 800/42 1 -2368  ext  353 


The  University  of  Colorado  School  of  Medicine 
Admissions  Committee 


Leigh  Truitt,  MD 
President,  1992-1993 


As  President  of  the 
Colorado  Medical  Society 
I have  been  a member  of 
the  Admissions  Committee 
of  the  School  of  Medicine 
for  the  last  year. 

William  C.  Bailey,  M.D.,  your 
new  President,  has  been  invited  to 
participate  this  year. 

This  has  been  an  enjoyable  but 
time-consuming  responsibility.  The 
Committee,  under  the  able  direction 
of  Maureen  Garrity,  Ph.D.,  Associate 
Dean  for  Admissions,  takes  very 
seriously  its  responsibility  to  admit 
each  year  a class  of  well-qualified 
men  and  women  to  the  CU  School  of 
Medicine.  These  qualifications 
include  not  only  excellent  academic 
credentials  but  a sincere  expression 
of  interest  in  contributing  to  the 
welfare  of  patients. 


Occasionally  assertions  have 
been  made  that  the  Committee  or  the 
School  has  created  quotas  for 
women,  minorities,  or  other  special 
groups.  I assure  you  that  this  is  not 
the  case.  The  University  of  Colorado 
does  desire  to  increase  the  represen- 
tation of  minorities  in  its  student 
body.  It  also  is  under  an  obligation  to 
increase  the  number  of  primary  care 
physicians  post  graduation.  To 
accomplish  the  first  goal,  preference 
is  given  to  minorities  in  selection  for 
interview  and  in  admission.  Addi- 
tional weighting  is  given  to  a rural 
background  and  a stated  preference 
for  primary  care  in  order  to  produce 
more  primary  care  physicians.  There 
are,  however,  no  numerical  quotas 
for  any  special  class.  Colorado 
residents  are  also  given  preference  in 
both  selection  for  interviews  and  in 
admission.  I am  sure  you  would  have 
it  no  other  way. 

One  of  our  problems  in  attract- 
ing highly  qualified  minorities  to  our 
School  of  Medicine  is  that  most  other 
medical  schools  feel  a similar 
obligation.  At  the  University  of 
Colorado,  we  have  very  limited 
scholarship  funds  and  cannot 
compete  with  many  public  and 
private  schools  in  other  states  in 
giving  financial  aid  to  highly  quali- 
fied minority  or  otherwise  disadvan- 
taged applicants.  This  is  a significant 
problem  in  attracting  such  student  to 
Colorado. 

I believe  that  it  would  enrich  our 
profession  as  well  as  the  health  care 
of  the  people  of  Colorado  to  recruit 
such  disadvantaged  students  to  our 
School  of  Medicine.  Therefore,  I 
have  proposed  that  the  Colorado 
Medical  Society  Education  and 
Research  Foundation  (CMS/ERF)  fund 
two  half-tuition  one  year  scholar- 
ships (approximately  $5,000  each) 


beginning  in  1 994  to  be  awarded  to 
disadvantaged  applicants  who  would 
otherwise  go  out  of  state  for  their 
medical  education.  Both  minority 
status  and  other  evidence  of  a 
disadvantaged  background  would  be 
considered  in  these  awards.  The 
applicants  would  be  nominated  by 
the  Admissions  Committee  and 
selected  by  the  CMS/ERF  Board  of 
Directors.  This  Board,  chaired  by 
Gerald  Rainer,  M.D.,  has  accepted 
this  proposal.  We  would  like  to  be 
able  to  continue  these  scholarships 
for  the  entire  four  years  of  medical 
school  but  the  current  funds  of  CMS/ 
ERF  are  not  sufficient  for  this  com- 
mitment. I intend  to  approach 
various  foundations  in  Colorado  to 
provide  additional  support.  I will 
also  be  asking  you  to  increase  your 
contributions  to  CMS  ERF  for  this 
purpose. 

I am  confident  that  the  selection 
of  the  Medical  School  class  is  a 
thoughtful,  equitable  process.  The 
Admissions  Committee  is  rationing  a 
very  scarce  resource  — 1 30  places 
each  year  in  the  University  of 
Colorado  School  of  Medicine.  There 
were  approximately  2,400  applicants 
in  1 993,  many  more  well-qualified 
than  could  he  accepted. 

To  be  a member  of  the  commit- 
tee is  a minimum  annual  commit- 
ment of  60  hours  of  your  time.  This 
is  truly  a labor  of  love  with  many 
members  of  the  committee  giving 
two  to  four  times  this  number  of 
hours.  If  any  of  you  desire  to  become 
a member  of  the  Committee  or 
would  like  to  discuss  this  process  in 
detail,  please  give  me  a call.  I hope 
you  will  all  support  our  goals  of 
filling  our  Medical  School  classes 
with  an  academically  well-qualified, 
diverse,  caring  representation  of  our 
people. 


302 


Colorado  Medicine  for  September,  1993 


Photo  by  Rocky  Mountain  News 


Golf  Fund  Raiser  a Success 


Colorado  Medical  Society's  Committee  on  Care  of  the  Medically  Indigent  holds 
physician  fund-raiser  and  awards  three  clinics. 


Gary  VanderArk,  M.D.,  chair  of  the  CMS  Committee  on  Care  for  the 
Medically  Indigent , presents  Dr.  & Mrs.  Robert  Williams  and  the  Inner  City 
Health  Center  a check  for  $5,000  as  a result  of  the  first  annual  fund-raiser 
held  by  the  committee  for  Colorado  clinics  treating  the  medically  indigent. 


On  May  24,  1993,  the  Colorado 
Medical  Society,  under  the  direction 
of  Gary  VanderArk,  M.D.,  chair  of 
the  CMS  Committee  on  Care  of  the 
Medically  Indigent,  held  its  first 
annual  golf  tournament  to  raise  funds 
for  organizations  in  the  state  which 
provide  care  to  the  medically 
indigent.  The  golf/tennis  classic  was 
held  at  the  Green  Gables  Country 
Club  in  Lakewood,  and  attracted 
nearly  40  physicians  and  commer- 
cial vendors.  Some  played  golf, 
others  played  tennis,  and  still  others 
fished.  The  tournaments  raised 
$ 1 0,000.  The  last  word  of  those  who 
actually  participated  in  the  golf 
tournament  was  "Be  sure  this  is  an 


The  Inner  City  Health  Center  is  well  equipped  with  used 
and  donated  equipment  to  carry  on  necessary  clinical  lab 
and  diagnostic  work.  However,  as  Executive  Director  )an 
Williams  says,  "We  are  always  in  need  of  equipment  AND 
money. " 


annual  CMS  event  for  the  medically 
indigent". 

Dr.  VanderArk  said  the  choices 
were  difficult  with  so  many  worth- 
while applicants,  but  the  final  choice 
went  down  to  three  clinics,  a first 
place  and  two  second  places.  They 
are  The  Inner  City  Health  Center  at 
3405  Downing  Street,  Denver  (1st 
Place,  receiving  $5,000)  and, 
receiving  $2,500  each,  the  Marillac 
Clinic,  Inc.,  in  Grand  Junction  and 
the  Women's  center  of  Larimer 
County. 

Robert  N.  Williams,  M.D.,  family 
practice  physician  from  Clear  Creek 
Valley  Medical  Society,  divides  his 
practice  between  his  Youngfield 
Street  offices  and  the  Inner  City 
Health  Center.  The  Inner  City  clinic 
does  family  and  pre-natal  care, 

dental  services,  family 
and  individual  medical 
counseling,  pediatrics 
and  also  has  a "Mom's 
Visitation  Project" 
which  trains  neighbor- 
hood mothers  to  make 
home  visits  to  mothers 
of  newborns.  Jan  (Mrs. 
Robert)  Williams  is  the 
director  and  takes  an 
active  part  in  nursing, 
counseling  and  busi- 
ness administration  in 
this  ten  year  old  clinic 
treating  primarily 
underserved  or  medi- 
cally indigent. 


Colorado  Medicine  for  September,  1993 


303 


Health 


System 


Reform 


by  Robert  M.  Bogin,  M.D.,  Chair 
Health  Systems  Reform  Committee 

and 

Jo  Parkin,  Program  Director 
Division  of  Health  Care  Financing 


ColoradoCare  and  Cost  Containment  Commission 


public  hearings  set 


"The  purpose  of  the 
hearings  is  to  obtain 
public  opinion 


r September 

Public  hearings  for  both  Colo- 
radoCare and  the  Colorado  Cost 
Containment  and  Guaranteed  Access 
Commission  - two  separate  groups  - 
are  being  held  during  the  month  of 
September.  The  purpose  of  the 
hearings  is  to  obtain  public  opinion 
on  Colorado  health  system  reform 
and  cost  containment  proposals 
under  development. 

ColoradoCare 

A number  of  Colorado  groups 
are  studying  health  care  issues  from 
a variety  of  perspectives.  The  most 
prominent  group  is  based  out  of  the 
Governor's  office  and  is  studying 
ColoradoCare,  a plan  to  provide 
universal  health  insurance  coverage 
for  all  Colorado  citizens.  The  study 
includes  analysis  of  a range  of 
benefit  package  options  and  the 
mechanisms  by  which  the  state 
could  finance  such  a proposal.  It  also 
addresses  quality  of  care  and  cost 
containment  considerations. 

While  the  study  puts  forth 
various  options  for  benefit  and 
financing  packages,  it  does  not 
specify  which  of  these  options  will 
ultimately  be  included  as  part  of  the 
final  ColoradoCare  proposal  submit- 
ted to  the  Legislature  in  the  form  of  a 
bill  - that  will  be  determined  by  the 
bill  sponsors.  The  final  report  on  the 
feasibility  study  was  due  to  the 
Legislature  by  July  31,1 993. 

The  next  step  in  the  Colo- 
radoCare process  is  public  hearings. 
Once  input  is  gained  from  the 


public,  the  advisory  committees  may 
reconvene  for  further  discussion. 
After  that,  a bill  will  probably  be 
developed  and  introduced  in  the 
1994  legislative  session. 

Colorado  Cost 
Containment  and 
Guaranteed  Access 
Commission 

The  Colorado  Cost  Containment 
and  Guaranteed  Access  Commission 
was  created  by  the  Legislature  in 
1992.  The  Commission  is  required  to 
submit  a report  by  December  1 993 
to  the  Governor,  Insurance  Commis- 
sioner and  Legislature  with  recom- 
mendations for  cutting  public  and 
private  health  care  costs.  Specifi- 
cally, the  report  is  to  include  recom- 
mendations for  cutting  the  rate  of 
health  care  cost  inflation  in  half 
relative  to  the  consumer  price  index 
by  1994  and  equal  to  Inflation  by 
1 996.  It  is  also  to  make  recommen- 
dations on  cost-effective  guaranteed 
access  programs.  At  the  request  of 
the  Governor,  the  Commission 
agreed  to  also  serve  as  the  cost 
containment  advisory  committee  to 
ColoradoCare.  In  all  other  respects, 
the  Commission  is  independent  of 
ColoradoCare. 

The  Commission  is  required  to 
hold  public  hearings  in  each  Con- 
gressional District  to  gather  informa- 
tion and  suggestions,  explain  the 
goals  of  the  commission  and  explain 


304 


Colorado  Medicine  for  September,  1993 


Health 


System 


Reform 


the  impact  of  various  proposals  that 
are  being  considered. 

Commission  members  were 
appointed  by  the  Governor  and 
include  representatives  from  each  of 
the  Colorado's  six  Congressional 
Districts  as  well  as  representatives  of 


many  constituencies  affected  by 
health  care  cost  containment  and 
guaranteed  access  issues.  The 
commission  has  been  meeting 
monthly  since  January. 

Listed  below  is  each  group's 
tentative  schedule  of  public  hearings: 


"the  report  is  to  include 
recommendations  for 
cutting  the  rate  of  health 
care  cost  inflation  in  half " 


ColoradoCare  Town  Hall  Meetings 

September  1 3 

Grand  Junction 

September  20 

Fort  Collins 

September  22 

Fort  Morgan 

September  23 

Colorado  Springs 

September  27 

Steamboat  Springs 

September  29 

Lamar 

October  4 

Boulder 

October  6 

Denver 

October  7 

Pueblo 

October  1 1 

Breckenridge 

October  1 3 

Durango 

October  1 4 

Alamosa 

Colorado  Cost  Containment  and 

Guaranteed  Access  Commission 

All  hearings  are  from  7:00  p.rri.  to  10:00  p.m. 

September  1 3 

Colorado  Springs 

September  14 

Denver 

September  20 

Alamosa 

September  22 

Boulder 

September  23 

Grand  Junction 

September  28 

Denver 

September  29 

Greeley 

We  have  been  advised  by  the  Governor's  office  that  THIS  LIST  IS 

SUBJECT  TO  CHANGE. 

Also,  at  the  time  of  this  writing,  specific  meet- 

ing  locations  had  not  yet  been  determined.  If  you  would  like  more 

information,  call  Jo  Parkin  at  CMS.  The  Colorado  Medical  Society  is 

arranging  to  have  CMS  members  attend  each  public  hearing. 

Colorado  Medicine  for  September,  1993 


305 


Edie  K.  Register,  Director 
Health  Care  Financing  Department 


Health 


Care 


Financing 


Modifiers  78  and  79  - Relationships 


"There  seems  to  be  a great 
deal  of  confusion  about 
how  one  should  use  these 
modifiers. " 


In  the  November,  1992  issue  of 
Colorado  Medicine,  I discussed 
modifier-25  and  would  remind  you 
that  this  modifier  goes  with  Evalua- 
tion and  Management  (E/M)  codes 
(Current  Procedural  Terminology 
(CPT)  99201-99499)  and  indicates 
that  the  evaluation  and  management 
service  was  a "significant,  separately 
identifiable...  service  by  the  same 
physician  on  the  day  of  a proce- 
dure". Remember  that  modifier  -25  is 
attached  to  the  E/M  CPT  code,  not 
the  code  representing  the  procedure. 

I would  like,  next,  to  discuss 
modifiers  -78  and  -79.  These  are 
attached  to  procedures  when  the 
procedures  occur  during  the  post- 
operative period  of  another  proce- 
dure. There  seems  to  be  a great  deal 
of  confusion  about  how  one  should 
use  these  modifiers  and  I believe  that 
the  confusion  arises  from  the  words 
"related"  and  "unrelated".  The 
American  Medical  Association's 
(AMA's)  CPT  manual  uses  these 
words  with  modifier  -78  and  -79.  but 
does  not  further  define  them. 

There  are  several  ways  that 
procedures  performed  on  the  same 
patient  can  be  related  or  associated. 
These  include  cause  and  effect,  one 
procedure  causing  or  bringing  about 
the  need  for  the  second  procedure; 
chronological,  one  procedure 
following  another,  performed  for  a 
different  diagnosis  from  the  first 
procedure  but  without  the  notion  of 
cause  and  effect;  different  stages  of  a 
staged  procedure;  diagnostic  and 
therapeutic  where  the  first  procedure 


Grant  Steffen,  MD,  Medical  Director 
Colorado  Carrier,  Medicare  Part  B 

makes  the  diagnosis  that  then 
dictates  the  need  for  the  second;  or 
failure  of  one  procedure  to  achieve  a 
goal  and  so  directing  the  need  for  the 
second  procedure. 

The  Health  Care  Financing 
Administration  (f-ICFA)  has  decided 
that,  for  Medicare  purposes,  the 
phrase  "related  procedure"  used  in 
defining  modifier  -78  means  a 
procedure  to  address  a complication 
of  the  prior  procedure.  Thus,  the  first 
relationship  mentioned,  i.e.,  cause 
and  effect,  is  the  one  that  defines 
modifier  -78.  A complication  of  the 
first  procedure,  not  the  patient's 
disease  creates  the  need  for  the 
second  procedure  and,  if  this  second 
procedure  is  done  in  the  operating 
room  and  during  the  post-operative 
period  of  the  first  procedure,  -78  is 
appended  to  the  CPT  code  of  the 
second  procedure  when  you  bill  this 
to  Medicare. 

While  the  patient's  condition 
may  well  contribute  to  the  occur- 
rence of  the  complication,  modifier  - 
78  implies  that  some  aspect  of  the 
procedure  caused  the  complication. 
There  is  no  implied  fault  or  blame  as 
there  was  under  the  old  system  that 
directed  payment  or  non  payment  for 
correction  of  surgical  complications. 
Under  that  system,  a surgeon  was 
not  paid  for  a return  trip  to  the 
operating  room  if  Medicare  decided 
that  the  complication  was  prevent- 
able, i.e.,  under  the  control  of  the 
surgeon. 

HCFA  defines  an  operating  room 
as  "a  place  of  service  specifically 


306 


Colorado  Medicine  for  September,  1993 


equipped  and  staffed  for  the  sole 
purpose  of  performing  procedures. 
The  term  includes  a cardiac  catheter- 
ization suite,  a laser  suite,  and  an 
endoscopy  suite.  It  does  not  include 
a patient's  room  or  an  intensive  care 
unit  (unless  the  patient's  condition 
precludes  transportation  to  the  OR)". 

Modifier  -79  is  used  to  identify 
an  "unrelated  procedure"  done 
during  the  post-operative  period.  As 
noted  above,  there  are  several  ways 
that  two  procedures  may  be  related, 
and  so  it  may  be  difficult  to  claim 
unrelated  status  for  any  procedure. 
HCFA  states  that  modifier  -79  should 
be  used  when  the  patient  is  returned 
to  the  OR  and  when  the  relationship 
between  the  two  procedures  is  not 
cause  and  effect,  i.e.,  the  second 
procedure  does  not  address  a 
complication  of  the  first  procedure. 
Any  of  the  other  relationships 
mentioned  allow  -79.  So,  "unre- 
lated" should  be  interpreted  nar- 
rowly to  mean  "not  for  a complica- 
tion of". 

Finally  note  that  -78  does  not 
indicate  that  the  modified  procedure 
is  done  by  the  same  physician  who 
did  the  first  procedure.  Thus,  modi- 
fier -78  is  used  when  the  patient 
returns  to  the  operating  room  for 
correction  of  a complication  even 
when  the  surgeon  who  does  the 
correcting  procedure  is  not  the 
surgeon  who  did  the  first  procedure. 
In  contrast,  -79  is  used  when  the 
physician  is  the  same  one  who  did 
the  first  procedure.  Further,  -79 
should  be  used  for  "unrelated 


Health  Care 


F 


I N A N C I N 


services " during  the  post-operative 
period  when  the  services  are  per- 
formed by  the  physician  who  did  the 
first  procedure.  If  a different  physi- 
cian does  the  procedure  or  does  the 
service,  no  modifier  is  needed. 

For  example,  -78  should  be  used 
with  a procedure  done  in  the 
operating  room  to  stop  a post- 
operative hemorrhage  or  to  repair  a 
significant  wound  dehiscence 
regardless  of  who  did  the  first 
surgery.  Modifier  -79  is  used  with  a 
procedure  that  is  done  by  the 
surgeon  who  did  the  first  procedure 
but  is  not  done  to  correct  a compli- 
cation, e.g.  an  open  reduction  of  a 
fractured  tibia  that  resulted  from  a 
fall  during  the  post-op  period  of  a 
total  hip  procedure.  If  the  surgeon 
who  repairs  the  tibia  is  not  the 
surgeon  who  did  the  total  hip,  no 
modifier  is  needed.  Exception:  If 
both  surgeons  are  in  a group  with 
one  provider  number,  then  they  are 
"the  same  physician"  and  modifier  - 
79  should  be  used. 

Note:  When  the  service  rendered 
by  the  same  physician  is  an  evalua- 
tion and  management  service  within 
the  post-operative  period,  use 
modifier  -24  for  the  E/M  service.  You 
might  wish  to  review  the  AMA's  CPT 
manual  on  these  points.  All  modifiers 
are  reprinted  in  Appendix  A. 


Modifier  -79  is  used  to 
identify  an  " unrelated 
procedure"  . . . interpreted 
narrowly  to  mean  "not  for 
a complication  of". 


Colorado  Medicine  for  September,  1993 


307 


Board 


Highlights 


HIGHLIGHTS  OF  BOARD  OF  DIRECTORS  MEETING  - 

July  1,  1993 

CMSA:  Mrs.  Pam  Laman,  President,  thanked  CMS  for  the  support,  both  financially 

and  personally,  given  to  Mrs.  Mary  Hanson  and  CMSA  during  Mrs.  Han- 
son's inaugural  proceedings  in  Chicago  in  June.  Mrs.  Laman  also  reported 
that  several  of  the  County  Alliances  were  developing  pamphlets  for  distribu- 
tion on  domestic  violence. 

AMA  Delegation:  Dr.  Joel  Karlin  reported  on  the  recent  AMA  Annual  Meeting  in  Chicago, 

stating  that  the  delegates'  report  from  the  AMA  was  an  accurate  description 
of  the  resolutions  and  reports. 

Medical  Student  Component:  Ms.  Theresa  Scholz  reported  that  an  active  interest  was  being  taken  in 

developing  a mentor  program  with  volunteer  members  of  CMS. 


Board  of  Directors:  The  Board  ratified  a motion  passed  by  the  Executive  Committee  to  be 

supportive  of  legislation  which  would  cause  state  regulatory  boards  to  work 
cooperatively  to  develop  regulations  addressing  health  care  in  underserved 
areas  while  assuring  quality  of  care. 

Ms.  Maloney  reported  to  the  Board  of  Directors  regarding  a retreat  recently 
attended  by  the  Medical  Executive  Group,  hosted  by  the  Colorado  Medical 
Society  and  facilitated  by  Ms.  Maloney.  The  purpose  was  to  identify  the 
strengths,  opportunities,  threats  and  weaknesses  facing  organized  medicine. 
Issues  identified  at  this  meeting  were  closely  related  to  issues  discussed  at 
the  President-Elect's  Planning  Conference  immediately  following  the  Board 
of  Directors  meeting. 


Colorado  Air  Quality  Control  Commission 


"public  comment  is 
accepted " 


The  next  meeting  of  the  Colo- 
rado Air  Quality  Control  Commission 
will  be  Thursday,  September  16, 

1 993  at  9:00  a.m.  at  the  Colorado 
Department  of  Health,  4300  Cherry 
Creek  Drive  South.  The  Commission 
meets  on  the  third  Thursday  of  every 
month.  Meetings  are  open  to  the 


public  and  public  comment  is 
accepted  on  agenda  items  as  well  as 
on  other  air  quality  issues.  Agendas 
are  usually  available  one  week  prior 
to  the  meeting  dates  from  the  CDH 
Air  Quality  Control  Commission, 
692-3180. 


308 


Colorado  Medicine  for  September,  1993 


Colorado  Ob/Gyn  Society 


Teen  Pregnancy  Prevention  Awareness  Week  A Success 


In  April  of  this  year,  the  Colorado 
ObGyn  Society  embarked  on  an 
ambitious  public  awareness  cam- 
paign aimed  at  increasing  public 
knowledge  concerning  the  problem 
of  teen  pregnancy  in  Colorado.  Ten 
posters  were  created  with  the  help  of 
the  Denver  Advertising  Foundation. 
These  were  copied  with  the  help  of 
Wyeth  Ayerst  Laboratories.  During 
and  after  the  month  of  April,  5,000 
posters  were  distributed  to  schools 
largely  in  the  Metro  Denver  area, 
and  areas  across  the  state. 

Teen  Pregnancy  Prevention  Aware- 
ness Week  was  declared;  culminat- 
ing in  a Teen  Pregnancy  Prevention 
Symposium  held  in  Denver  on  April 
16,1993.  Over  280  participants 
from  across  the  state  created  a 
dialogue  concerning  this  issue. 


Attendees  included  ObGyn  physi- 
cians, family  physicians,  pediatri- 
cians, educators,  school  nurses, 
teenagers,  professionals  running 
prevention  programs,  representatives 
of  foundations  interested  in  this 
issue,  and  representatives  of  parent 
organizations.  A press  conference 
was  held  announcing  the  Week,  and 
coverage  included  a front  page 
article  In  the  Rocky  Mountain  News, 
as  well  as  reports  in  papers  through- 
out the  state. 

A proclamation  was  issued  by 
the  Governor,  acknowledging  his 
support  for  this  effort,  and  billboards 
and  bus  signs  went  up  throughout 
the  Denver  area,  portraying  two  of 
the  visual  concepts  from  the  posters. 

Speakers  Bureau  and  Posters 


Betsy  Fox,  Public  Relations  Director 

• For  information  about  community 
programs,  call  355-8845. 

• For  information  about  membership 
meetings,  call  693-6127. 


Available 

The  Colorado  ObGyn  Society 
will  continue  to  offer  free  teen 
pregnancy  prevention  posters  to  the 
public.  There  are  10  concepts  In 
each  set  of  posters.  A Speakers 
Bureau  will  also  be  made  available 
concerning  this  issue.  To  order 
posters  or  schedule  a speaker, 
contact  Betsy  Fox  at  355-8845. 

September  Membership  Meeting 

The  September  Colorado  ObGyn 
Society  Membership  meeting  will  be 
held  September  1 3 at  the  Marriott 
Southeast.  Cocktails  at  6 pm; 
dinner  at  6:45  pm.  The  featured 
speaker  will  be  Kenneth  Hatch,  MD, 
concerning  "Management  of  HPV 
and  the  Atypical  Pap  Smear". 


THE  ARMY  RESERVE  OFFERS  UNIQUE  AND 
REWARDING  EXPERIENCES. 


As  a medical  officer  in  the  Army  Reserve  you  will  be  offered 
a variety  of  challenges  and  rewards.  You  will  also  have  a unique 
array  of  advantages  that  will  add  a new  dimension  to  your 
civilian  career,  such  as: 

• special  training  programs 

• advanced  casualty  care 

• advanced  trauma  life  support 

• flight  medicine 

• continuing  medical  education  programs  and  conferences 

• physician  networking 

• attractive  retirement  benefits 

• change  of  pace 

It  could  be  to  your  advantage  to  find  out  how  well  the  Army 
Reserve  will  treat  you  for  a small  amount  of  your  time.  An  Army 
Reserve  Medical  Counselor  can  tell  you  more,  call: 


1-800-432-7279 

ARMY  RESERVE  MEDICINE.  BE  ALL  YOU  CAN  BE.' 


Colorado  Medicine  for  September,  1993 


309 


Letters 


Colorado  Medicine 
welcomes  your  input. 
Please  address 
correspondence  to:  Editor ; 
Colorado  Medicine,  PO 
Box  17550 , Denver ; CO 
80217-0550. 


July  30,  1993 


Dear  Editor: 

I was  very  pleased  to  see  passage 
of  Resolution  27P:  "RESOLVED", 
that  the  Colorado  Medical  Society 
and  its  physicians  shall  not  discrimi- 
nate on  the  basis  of  sexual  orienta- 


Physician Recognition  Awards 

The  Colorado  Medical  Society  joins  the  American  Medical  Association  in 
recognizing  the  following  physicians  for  their  dedication  to  excellence  in 
the  profession  of  medicine,  as  demonstrated  in  their  commitment  to 
continuing  medical  education. 


David  M Abbey 

John  C Maisel 

David  M Barrs 

Benjamin  Martinez 

Richard  F Beatty 

Donald  K McClure 

Richard  F Bedell 

Martin  D McDermott 

Paul  D Bostrom 

Solbritt  E S Murphy 

Curtis  C Clark 

Howard  E Netz 

George  F Cresswell 

David  A Oppenheimer 

Robert  A Dragoo 

Ronald  L Peveto 

Donald  W Fink 

Kathleen  Y Sawada 

Jim  G T Foust 

Sharon  K Schaefer 

G T Jim  Foust 

John  L Smith 

Thomas  M Golbert 

Marc  J Sorkin 

Lawrence  N Gorab 

Duane  R Spaulding 

B T M Graver-Bugajski 

Gordon  K Tagge 

John  S Heavrin 

Celsa  T Tiu 

Glenn  O Hewitt 

Lisa  M Toepp 

Kelly  V Holmes 

Steven  M Traina 

Dudley  H Kersey 

Michael  S Victoroff 

John  S Lavengood 

Chester  M Wigton 

John  S Lemley 

Diane  L Wing 

tion,  age,  or  gender,  religion, 
national  origin,  skin  color  or  disabil- 
ity. 

It  is  a credit  to  the  Medical 
Society  and  its  members  that  the 
resolution  was  passed. 

Sincerely, 

Ingrid  M.  Justin,  M.D.,  P.C. 


Worried 
about  losing 
everything 
in  a lawsuit? 

Physicians  and  other  professionals 
are  sued  when  everything  doesn’t 
turn  out  as  expected.  Learn  how 
you  can  protect  your  assets  from 
lawsuits  by  calling  Ted  Gelt,  head 
of  our  Business  and  Estate 
Planning  Department,  or  Harry 
Sterling,  head  of  our  Asset 
Protection  Department. 

GELT,  FLEISHMAN  & 
STERLING  P.C, 

ATTORNEYS  AND 
COUNSELORS  AT  LAW 

SUITE  2600 
1600  BROADWAY 
DENVER,  COLORADO  80202 

(303)  861-1000 


310 


Colorado  Medicine  for  September,  1993 


UNDERSTANDING 

HEALTH  CARE  INTEGRATION  - PART  II 


by  Ted  Lewis,  M.D.,  Director  of  Medical  Education 
Penrose-St.  Francis  Hospital 
Colorado  Springs,  Colorado 


Ed:  The  following  is  the  second  of  a two-part  article  written  by  Dr.  Ted  Lewis  and  published  in  the  Penrose-St.  Francis 


Medical  Staff  Monthly,  May,  1993. 

Perhaps  the  greatest  challenge 
for  the  United  States  in  the  1990s 
will  be  trying  to  solve  the  dilemma 
we  face  in  the  health  care  industry. 
During  the  last  Presidential  election, 
health  care  was  placed  on  the  front 
burner  as  one  of  the  two  major 
problems  confronting  our  country 
today,  the  other  being  the  economy. 
Why  all  the  fuss  over  health  care  and 
why  now? 

The  newly  appointed  Secretary 
of  Health  and  Human  Services,  Dr. 
Donna  Shalala,  recently  spoke  to  the 
issue  on  CNN's  Larry  King  Show. 

She  admitted  we  have  the  best  health 
care  that  can  be  provided  in  the 
world  for  those  who  can  pay  for  it. 
The  problem  is  that  increasingly 
more  and  more  Americans  cannot 
afford  the  cost  and  are  being  left  out 
or  driven  out  because  of  lack  of 
access  or  affordability.  Adding  to 
these  problems  are  increasing 
governmental  regulations,  contribut- 
ing to  overhead  and  administrative 
costs  now  estimated  to  be  24  percent 
of  the  total  spent  on  health  care.  The 
application  of  new  technology, 
though  most  agree  it's  highly  desir- 
able, is  a major  factor  fueling  the 
fire.  Add  the  costs  of  "defensive 
medicine"  and  the  continuing  threat 
of  malpractice,  it  is  no  wonder  the 
health  care  engine  is  overheated, 
speeding  along  at  an  ever-increasing 
rate  to  crisis  and  derailment. 

It  is  not  likely  that  just  placing 
price  caps  or  global  budgeting  will 
bring  this  speeding  engine  under 
control  in  a free  society  that  prides 
itself  on  letting  the  free  market 


system  make  economic  adjustments. 
This  is  a monster  that,  unless  a new 
direction  or  "a  switch  to  another 
track"  is  implemented,  a disaster 
awaits  us  down  the  line.  Former 
Governor  Richard  Lamm  reminds  us 
that  health  care  will  consume  all  our 
national  resources  (1 00%  of  the 
GNP)  by  the  year  2050  unless  we 
make  changes  in  the  way  we  deliver 
health  care. 

Part  of  the  problem  is  that  we 
don't  have  a "healthcare  system"  but 
a "healthcare  industry."  It's  made  up 
of  a patchwork  of  physicians,  group 
practices,  clinics,  public  health 
departments,  private  and  public 
hospitals,  nonprofit  and  for  profit, 
religious,  community,  teaching, 
university  based,  general  and 
specialized;  funded  by  patients, 
employers,  a multitude  of  insurance 
companies,  state,  local  and  federal 
governments;  connected  by  an 
impossible  number  of  contractual 
and  voluntary  arrangements  without 
any  system  goals  or  incentives.  The 
problem  is  that  with  no  societal  goals 
or  guiding  public  policies,  the  focus 
is  on  only  caring  for  the  sick  or 
injured  with  little  interest  on  keeping 
people  healthy.  We  pay  for  proce- 
dures, drugs,  tests  and  treatments 
instead  of  rewarding  health  care 
providers  with  financial  incentives  to 
keep  people  well. 

However,  there  is  a new  move- 
ment, "a  happening",  in  the  health 
care  industry.  "Integrated  systems" 
are  emerging  in  hot  spots  around  the 
country  combining  physicians, 
hospitals,  clinics,  insurance  plans, 
home  health  agencies,  and  long-term 


care  facilities  into  vast  entities.  These 
systems  are  intriguing,  holding  a 
promise  that  with  such  a comprehen- 
sive system  guided  by  a common 
vision  and  mission,  efficiencies  can 
be  realized  that  provide  quality 
health  care  at  a more  reasonable 
cost.  The  prospect  is  that  these 
entities  can  bid  on  providing  total 
health  care  for  a fixed  fee  to  large 
population  groups.  Their  advantage 
is  simple.  These  integrated  systems 
will  not  be  paid  by  the  procedure, 
the  disease,  or  hospital  admission, 
but  by  the  number  of  covered  lives. 
They  will  have  every  incentive  to 
keep  their  populations  as  healthy  as 
possible.  This  may  be  the  most 
reasonable  alternative  to  our  hodge- 
podge of  health  care  services  and  a 
much  better  alternative  to  a rigid 
single-payer,  government-sponsored 
social  program. 


311 


Colorado  Medicine  for  September,  1993 


E 


ntertainment  is  killing  us 


"...  if  a mother  came 
home  to  find  a scruffy 
stranger  in  her  living  room 
showing  her  ten-year-old 
how  to  load  a revolver  she 
would  call  the  police. 

If  the  boy  is  sitting  there 
learning  the  same  thing 
from  the  TV  screen , she 
hardly  notices. " 


The  other  day  on  C-Span  I 
watched  the  president  and  lobbyist 
of  the  Motion  Picture  Association  of 
America,  Mr.  Jack  Valenti,  in  front  of 
a Congressional  hearing  panel, 
pretending  that  mindless  violence 
shown  on  the  screens  of  his  "enter- 
tainment" industry  could  not  be  a 
provocation  to  mindless  violence  in 
real  life.  Mr.  Valenti,  sophisticated 
and  intelligent,  was  trying  to  appear 
naive  by  being  affable  and  glib.  His 
attitude  implied  that  death  in  living 
color  showing  bullets  and  blood  and 
brains  splattered  on  restaurant  walls 
could  not  incite  murder  by  some 
angry  unloved  youth  carrying  a 
grudge  and  a loaded  gun.  Mr. 

Valenti  cast  about  for  other  things  to 
blame  for  the  increase  in  human 
violence,  like  the  social  and  moral 
deterioration  of  families,  the  scarcity 
of  jobs,  all  of  course  beyond  the 
responsibility  of  the  movie  industry. 

It  did  not  seem  to  occur  to  him  that 
for  the  angry  child  of  a disintegrated 
family  a violent  and 
vengeful  TV  show  can  be 
nothing  but  provocation. 

Mr.  Valenti's 
closing  remarks  were 
ambivalent.  "I  can't 
warrant  you  that  we  can 
reduce  the  violence.  Will 
we  try  our  damnedest? 
Yes."  Whatever  that 
meant.  I would  hope  for 
action  except  that  the 
industry  Mr.  Valenti 
represents,  and  tries  to 
exonerate,  has  a lot  in 
common  with  the  tobacco 
industry.  It  is  loaded  with 
highly  paid  people  flooding  a free 
market  with  packages  of  addictive 


material  bringing  them  a tremendous 
cash  income.  They  don't  care  who 
buys  it  or  who  sees  it. 

Screenwriters,  producers  and 
directors  make  their  living  by 
showing  casual  unprotected  het- 
erosex as  if  there  were  no  AIDS 
epidemic.  Special  effects  technolo- 
gists devise  more  "realistic"  ways  to 
spout  blood  from  bullet  holes  in 
people's  foreheads  and  chests.  They 
show  men  brandishing  knives  in  the 
faces  of  women.  They  are  proud  of 
their  work  and  their  pay,  hoping  for 
an  Oscar. 

It  is  not  realistic  to  expect  self- 
regulation from  these  people.  Ted 
Turner  himself  told  a Congressional 
committee  he  had  little  confidence 
that  the  industry  will  police  itself 
with  a rating  system.  He  said  that  TV 
violence,  including  some  in  his  own 
TNT  network,  was  to  blame  for 
causing  violence  in  America.  But 
then  his  "solution"  would  be  a 
gadget  that  working  parents  could 
wire  into  a TV  set  to  block  out 
selected  violent  programs.  That  is 
Mr.  Turner's  variation  on  the  cliche 
"If  you  don't  like  it,  turn  it  off".  He 
presumes  every  household  has 
caring  parents  and  money  for  the 
gadget.  Thousands  of  households 
have  neither.  Young  kids  in  a 
parentless  household  are  not  turning 
it  off. 

"Entertainment"  moguls  don't 
want  to  admit  the  bad  effects  of  a 
violent  TV  drama  on  emotionally 
immature  viewers.  Do  they  presume 
that  every  child  is  defended,  that 
every  young  teen  feels  secure?  There 
are  different  kinds.  Some  parents 
show  love  for  their  children,  teach 
them  respect  for  the  feelings  of 


312 


Colorado  Medicine  for  September,  1993 


by  Thomas  H.  Coleman,  M.D. 

Denver,  Colorado 


others,  some  don't.  Some  kids  don't 
have  parents.  Sesame  Street  is  not 
their  idea  of  a cool  show.  Mr.  Valenti 
appears  unaware  of  brigades  of 
amoral  quick  learners  out  there  eager 
to  act  out  any  new  TV  excitement, 
especially  with  a cheap  gun.  Their 
role  models  are  bad  guys.  Their 
family  is  a gang.  Their  teacher  is  a 
TV  set.  They  watch  violent  TV 
shows.  22  to  34%  of  young  male 
felons  in  prison  for  assault,  rape  and 
murder  said  they  learned  their 
techniques  of  criminal  behavior  by 
watching  TV.  In  a TV  discussion  of 
violence  one  panelist  made  the  point 
that  if  a mother  came  home  to  find  a 
scruffy  stranger  in  her  living  room 
showing  her  ten-year-old  how  to 
load  a revolver  she  would  call  the 
police.  If  the  boy  is  sitting  there 
learning  the  same  thing  from  the  TV 
screen,  she  hardly  notices. 

The  networks  and  movie  indus- 
try seem  committed  not  only  to  the 
destruction  of  people,  but  of  tradi- 
tional social  order  and  values.  They 
show  just  anybody  with  an  assault 
rifle  mowing  down  policemen,  men 
and  women  of  the  ATF,  the  DEA, 

FBI,  and  the  troopers  of  the  highway 
patrol.  What  is  the  purpose?  Does 
anyone  believe  this  does  no  harm  to 
the  morale  and  spirit  of  the  people 
who  enforce  the  law?  That  it  does 
not  encourage  an  aggressive  crimi- 
nal? These  murders  are  committed  in 
scenes  of  extravagant  destruction, 
the  blowing  up  of  BMWs,  squad 
cars,  helicopters  and  limousines, 
incinerating  the  people  inside  them. 
Nobody  on  screen  is  outraged;  no 
one  grieves;  no  one  is  in  a burn 
center  with  terrible  pain.  It  is  a 
realistic  display  of  murder  without 


the  reality  of  human  consequences. 

Media  people  deny  the  connec- 
tion between  their  killings  and  the 
violence  of  real  life  if  they  don't  read 
or  don't  believe  the  solid  medical 
evidence.  Since  1982  there  have 
been  20  long-term  field  studies 
showing  that  TV  violence  is  respon- 
sible for  the  increase  in  aggressive 
violence  in  children. 

Even  children  only  14  months 
old  imitate  behavior  they  have  seen 
on  TV. 

Three-  and  four-year- 
olds  watching  TV  can't 
distinguish  between  the 
fantasy  and  reality,  even 
when  coached  and  reas- 
sured by  adults.  For  those 
children  TV  is  a source  of 
factual  information  about 
the  world. 

In  a Canadian  town 
without  television,  aggres- 
sive behavior  in  first-  and 
second-graders  was  studied 
for  two  years,  then  studied 
again  two  years  after  TV 
arrived.  The  rate  of  physical 
aggression  in  the  town's  children  had 
increased  by  160%. 

In  1 945  in  the  white  population 
of  the  U.S.  there  were  3 murders  per 
1 00,000.  After  thirty  years  of  televi- 
sion the  rate  had  increased  93%  to 
5.8  per  100,000.  A similar  study  in 
Canada  showed  the  same  thing,  with 
92%. 

George  Gerbner  in  the  Univer- 
sity of  Pennsylvania's  Annenberg 
School  of  Communications  told  the 
National  Cable  Television  Associa- 
tion that  programs  for  children, 
including  cartoons,  show  violent  acts 
from  five  to  eight  times  per  program, 


"It  is  a realistic  display  of 
murder  without  the  reality 
of  human  consequences." 


SHOCK!  Front  page  picture  in  a local 
newspaper , and  a photo  that  appeared  in 
newspapers  across  the  country,  showing 
a man's  disregard  for  authority  pointing  a 
firearm  at  the  head  of  a policeman 
because  he  disagreed  with  the 
policeman 's  order. 


(Continued  on  following  page) 


Colorado  Medicine  for  September,  1993 


313 


Entertainment  • • • (Continued) 


"...  repeated  and  escalat- 
ing violence  approaches 
saturation  until  people 
feel  helpless  and  are  ready 
to  accept  it  as  a " normal " 
hazard  of  life." 


and  from  1 7 to  32  times  per  hour. 

In  1990  the  American  Academy 
of  Pediatrics  recommended  that  "In 
the  light  of  research,  pediatricians 
should  advise  parents  to  limit 
children's  TV  viewing  to  one  or  two 
hours  a day".  That  same  year  U.  S. 
children  aged  two  to  five  years  were 
watching  more  than  27  hours  of 
television  per  week. 

Dr.  C.  Everett  Koop,  pediatrician 
and  former  Surgeon  General,  re- 
ported that  from  1 960  to  1 980  the  U. 
S.  population  increased  26%  while 
murders  by  gunshot  rose  1 60%. 
Gunshot  is  now  the  leading  cause  of 
death  in  America's  teen-age  boys, 
both  blacks  and  whites.  Gun  deaths 
in  the  U.  S.  are  seven  times  those  in 
the  United  Kingdom.  Increasing 
numbers  of  children  and  adolescents 
have  used  guns  to  kill  themselves.  In 
31  Illinois  high  schools  one  third  of 
the  students  had  brought  weapons  to 
school  for  "self-defense". 

It  is  encouraging  to  see  people  of 
prestige  in  the  press,  in  the  medical 
journals  and  social  foundations 
tapping  the  television  and  movie 
people  on  the  shoulder  to  say  wait 
just  a minute,  what  the  heck  do  you 
think  you're  doing?  Columnist 
Thomas  Sowell  is  concerned  about 
TV  invading  the  privacy  of  the  family 
while  mothers  are  too  busy  working 
or  buying  the  groceries  to  control 
what  their  kids  watch.  Columnist 
Joseph  Perkins,  San  Diego  Union- 
Tribune,  is  concerned  about  violent 
shows  teaching  violence.  He's  also 
cynical  about  the  TV  networks  tuning 
out  their  own  violent  shows.  They 
say  it  would  lose  them  "too  much 
money".  USA  Weekend,  a newspa- 
per supplement,  surveyed  71 ,000 


readers.  96%  said  television  glorifies 
violence.  86%  said  their  children 
had  noticeable  changes  in  behavior 
after  watching  a violent  TV  show. 
56%  said  TV  producers,  writers  and 
executives  should  take  the  lead  in 
controlling  the  problem.  Only  1 1% 
said  the  government  should,  only 
1 3%  said  that  advertisers  should. 

The  media  not  only  deny  they 
could  be  wrong,  they  are  sanctimo- 
nious about  their  own  freedom  of 
speech  while  they  ignore  the  right  of 
others  to  privacy.  They  have  it  both 
ways.  Their  violent  shows  provoke 
real  violence,  they  show  the  real 
violence  in  the  name  of  "honesty" 
and  the  "people's  right  to  know".  On 
their  talk  shows  they  interview  the 
most  disreputable  people  (sometimes 
in  prison),  memorialize  them  in 
"docudramas"  and  pay  them  royal- 
ties for  their  movies  and  books.  In 
their  book  crime  pays,  a lot. 

In  America  we  are  well  into  a 
state  of  mind  where  repeated  and 
escalating  violence  approaches 
saturation  until  people  feel  helpless 
and  are  ready  to  accept  it  as  a 
"normal"  hazard  of  life.  If  thirty 
percent  of  the  population  had  lock- 
jaw or  tuberculosis  would  we  accept 
it  as  a standard  of  health?  We  are  not 
helpless.  We  can  bring  pressure  on 
the  Congress  and  the  networks  to 
take  a big  responsibility.  It's  about 
time. 


314 


Colorado  Medicine  for  September,  1993 


Health  Care  Definitions 

The  definition  of  terms  in  health  care  financing  and  of  terms  related  to  delivery,  provision  and 
evaluation  of  care. 

Colorado  Medicine  suggests  you  keep  these  monthly  articles  and  definitions,  even  though  many  will 
change,  some  will  disappear  and  new  ones  will  appear  as  the  health  system  reform  unfolds. 


TERMS  RELATED  TO  FINANCING 
HEALTH  CARE 

APPROPRIATION:  In  Federal  and  State 
budgets,  an  act  of  legislation  that  per- 
mits Federal  and  State  agencies  to  in- 
cur obligations  and  to  make  payments 
out  of  the  Treasury  for  specified  pur- 
poses. An  appropriation  usually  fol- 
lows enactment  of  authorizing  legisla- 
tion. An  appropriation  is  the  most 
common  form  of  budget  authority,  but 
in  some  cases  the  authorizing  legisla- 
tion provides  the  budget  authority. 
Appropriations  are  categorized  by  their 
period  of  availability  (one-year,  mul- 
tiple-year, no-year),  the  timing  of  legis- 
lative action  (current,  permanent),  and 
how  the  amount  of  the  appropriation  is 
determined  (definite,  indefinite). 

CHARGES/COSTS:  Prices  assigned  to 
units  of  medical  service,  such  as  a visit 
to  a physician  or  a day  in  a hospital. 
Charges  for  services  may  not  be  related 
to  the  actual  costs  of  providing  the 
services.  Further,  the  methods  by  which 
charges  are  related  to  costs  vary  sub- 
stantially from  service  to  service  and 
institution  to  institution.  Different  third 
party  payers  may  require  use  of  differ- 
ent methods  of  determining  either 
charges  or  costs.  Charges  for  one 
service  provided  by  an  institution  are 
often  used  to  subsidize  the  costs  of 
other  services.  Charges  to  one  type  or 
group  of  patients  may  also  be  used  to 
subsidize  the  costs  of  providing  ser- 
vices to  other  groups. 

COMMUNITY  RATING:  A method  of 
establishing  premiums  for  health  in- 
surance in  which  the  premium  is  based 
on  the  average  cost  of  actual  or  antici- 
pated health  care  used  by  all  subscrib- 


ers in  a specific  geographic  area  or 
industry  and  does  not  vary  for  different 
groups  or  subgroups  of  subscribers  or 
with  such  variables  as  the  group's 
claims  experience,  age,  sex,  or  health 
status.  The  Health  Maintenance  Orga- 
nization (HMO)  Act  defines  commu- 
nity rating  as  a system  of  fixing  rates  of 
payments  for  health  services  which 
may  be  determined  on  a person  or  per 
family  basis  "and  may  vary  with  the 
number  of  persons  in  a family,  but 
must  be  equivalent  for  all  individuals 
and  for  all  families  with  similar  com- 
positions." The  intent  of  community 
rating  is  to  spread  the  cost  of  illness 
evenly  over  all  subscribers  (the  whole 
community)  rather  than  charging  the 
sick  more  than  the  healthy  for  health 
insurance.  Community  rating  is  the 
exceptional  means  of  establishing 
health  insurance  premiums  in  the 
United  States  today. 

COPAYMENT:  A type  of  cost  sharing 
whereby  insured  or  covered  persons 
pay  a specified  flat  amount  per  unit  of 
service  or  unit  of  time  (e.g.,  $2  per  visit, 
$10  per  inpatient  hospital  day),  their 
insurer  paying  the  rest  of  the  cost.  The 
copayment  is  incurred  at  the  time  the 
service  is  used.  The  amount  paid  does 
not  vary  with  the  cost  of  the  service 
(unlikecoinsurance,  which  is  payment 
of  some  percentage  of  the  cost). 

COVERED  SERVICES:  All  benefitpack- 
ages  have  a defined  set  of  basic  ben- 
efits. In  managed  care,  there  are  spe- 
cific limitations  on  what  is  covered. 

NEXT  MONTH: 

Deductible 

Experience  Rating 

Insurance  Benefits 


NOTE: 

Today ; a new  health 
care  field , particularly  in 
areas  of  medical  prac- 
tice, is  evolving  around 
an  entirely  new  language. 
Many  of  us  suffer  from 
lack  of  knowledge  of  the 
terminology  and,  there- 
fore, incorrectdetinitions. 

As  a result Colorado 
Medicine  is  starting  a new 
monthly  feature  to  help 
practitioners  in  the  ver- 
bal minefield  of  " loaded 
terms". 

Here , then , begins  the 
"Health  Care  Language 
Primer. " 


Colorado  Medicine  for  September,  1993 


315 


Times  Change 


The  following  was  submitted  to  Colorado  Medicine  by  George  O.  Thomasson,  M.D.,  Vice  President , Risk  Manage- 
ment, Copic  Insurance  Company,  March,  1 989.  It  is  even  more  apropos  today. 


"Is  it  possible  that  part  of 
this  paradox  is  the 
inability  of  the  individual 
physician  to  represent  the 
problems  presented  by 
medicine  as  a profession 
to  society?" 


I entered  the  practice  of  medi- 
cine more  than  25  years  ago  and 
recall  at  that  time  the  individualism 
and  independent  decision  making 
which  was  a characteristic  of  the 
practice  of  medicine.  That  image 
was  supported  both  by  our  peers  as 
well  as  our  patients.  During  the  past 
ten  to  twelve  years,  the  image  of  the 
independent  physician  seems  to 
have  become  that  of  the  recalcitrant 
curmudgeon  resistant  to  change.  This 
is  best  demonstrated  by  the  paradox 
of  the  positive  response  to  questions 
posed  to  patients  about  their  respect 
for  their  own  physician  as  opposed 
to  their  negative  response  when 
questioned  about  medicine  as  a 
profession.  Is  it  possible  that  part  of 
this  paradox  is  the  inability  of  the 
individual  physician  to  represent  the 
problems  presented  by  medicine  as  a 
profession  to  society  in  an  under- 
standable fashion?  If  so,  then 
participating  in  a group  with  the 
expertise  to  address  these  problem 
areas  in  an  effective  manner  may 
help  resolve  this  problem. 

The  importance  of  this  approach 
then  resolves  itself  into  four  areas: 

1.  The  community 

2.  Quality  of  Medical  Care 

3.  Reimbursement  Issues 

4.  Medical  Liability 

By  participating  in  the  Colorado 
Medical  Society  as  Chairman  of  the 
Council  on  Community  Health 
Issues,  I have  had  a unique  opportu- 
nity to  work  with  many  dedicated 
physicians  from  a variety  of  commu- 
nities around  the  State  of  Colorado. 
This  has  resulted  in  an  opportunity  to 
focus  on  a variety  of  community 
health  issues  by  networking  these 
dedicated  physicians  with  individu- 
als in  their  community  who  were 


concerned  about  issues  of  health 
status,  environmental  hazards, 
resource  allocation,  and  a myriad  of 
other  interests.  The  resulting  out- 
come was  a synergism  of  the  energy 
of  the  community  leaders  with  the 
technical  skills  of  their  physician 
counterparts.  The  ability  to  network 
requires  a focus  and,  in  Colorado, 
the  Medical  Society  has  provided 
that  focus  in  a very  professional 
manner. 

Many  organizations  have 
entered  the  arena  of  defining  quality 
of  medical  care.  This  is  not  a new 
area  of  interest  and  in  particular  has 
been  a focus  of  attention  by  philoso- 
phers, ethicists,  and  harried  physi- 
cians probably  from  time  immemo- 
rial. It  is  interesting  to  pursue  our 
individual  biases  in  this  area  from 
the  extremes  of  occasional  cocktail 
party  debates  to  the  more  formal 
seminars  dedicated  to  this  area.  For 
an  effective  move  toward  resolving 
the  problem,  a group  of  professionals 
dedicated  to  that  end  must  exist.  An 
example  of  the  organizational 
approach  in  this  area  was  a project 
developed  about  four  years  ago  by 
the  Colorado  Academy  of  Family 
Practice  in  conjunction  with  the 
Colorado  Medical  Society,  and  the 
Copic  Insurance  Company  to  address 
the  concerns  that  the  Family  Practi- 
tioners in  Colorado  had  about 
continuing  obstetrics  as  part  of  their 
specialty.  The  logistics  of  this 
project  would  have  been  very 
difficult  for  a small  group  of  indi- 
vidual physicians  to  pursue.  With 
the  commitment  of  the  individual 
organizations  involved  which 
subsequently  also  involved  the 
Colorado  Department  of  Health, 
some  significant  inroads  have  been 


316 


Colorado  Medicine  for  September,  1993 


■ 


by  George  O.  Tbomasson,  MD 
Vice  President,  Risk  Management 
Copic  Insurance  Company 


made  in  reducing  the  confusion 
about  the  most  effective  way  to 
approach  the  concept  of  quality  in 
relationship  to  obstetrical  care 
services  in  Colorado. 

Although  my  current  practice 
does  not  provide  a day-to-day 
involvement  with  the  myriad  of 
reimbursement  systems  that  the 
practicing  physician  encounters,  it 
does  provide  me  a unique  opportu- 
nity to  talk  with  a large  segment  of 
Colorado  physicians.  The  frustration 
of  contending  with  these  reimburse- 
ment systems  comes  across  loud  and 
clear  and  is  compounded  by  the 
individual  physician's  feeling  of 
ineffectiveness  when  encountering 
the  bureaucracy  that  stands  behind  a 
particular  payment  system.  The 
Colorado  Medical  Society  has 
demonstrated  its  effectiveness  again 
in  enhancing  the  activity  of  indi- 
vidual physicians  by  focusing  on 
specific  reimbursement  problems 
and  addressing  those  issues  in  a 
precise  fashion.  The  dedication  of 
individual  physician  members  of  the 
Society  who  participate  in  these 
activities  has  been  well  rewarded. 
The  Society  continues  to  provide 
leadership  both  statewide  and 
nationally  in  areas  which  will  impact 
the  future  reimbursement  of  all 
physicians  practicing  in  the  state. 

In  my  own  area  of  dealing  on  a 
daily  basis  with  medical  liability 
issues,  I have  clearly  seen  the 
advantage  of  the  organizational 
approach  to  problem  solving.  The 
Medical  Society's  participation  along 
with  other  dedicated  agencies  in 
addressing  the  need  for  effective  tort 
reform  in  the  State  of  Colorado  has 
provided  a format  for  the  individual 
physician  to  focus  his  or  her  energies 


in  an  effective  manner.  This  was 
subsequently  rewarded  in  a tangible 
fashion  with  the  acceptance  by  the 
legislature  of  the  Health  Care 
Availability  Bill.  The  ability  of  a few 
physicians  to  affect  a product  of  that 
type  in  this  age  of  bureaucratic 
decision  making  and  vested  interest 
pressure  groups  is  unlikely. 

As  society  continues  to  struggle 
with  the  dilemma  of  quality  versus 
cost  in  the  arena  of  health  care,  it  is 
of  paramount  importance  that 
medicine  maintain  a leadership  role. 
Far  this  to  be  most  effectively  done, 


each  physician  must  contribute  to  a 
process  which  insures  that  their 
individual  interests  and  expertise  are 
well  represented.  In  my  opinion,  this 
will  best  be  accomplished  by  partici- 
pating in  an  effective  organization 
dedicated  to  the  interests  of  the 
physicians  it  represents  and  the 
community  it  serves. 


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For  more  information  about  The  St.  Paul’s  medical  professional 
liability  insurance  contact  your  independent  insurance  agent  or  the 
Denver  Service  Center. 


Colorado  Medicine  for  September,  1993 


317 


Health  Department 


"Colorado  Department  of  Health  Issues  New  Report:  Diabetes 

Prevalence  and  Morbidity  in  Colorado  Residents,  1980-1991" 


by  Jackie  Starr-Bocian  Senior  Public 
Information  Officer  Colorado 
Department  of  Health 


Background: 

This  report  reviews  diabetes  in  Colo- 
rado between  7 980- 1991  .It involved 
researching  Colorado  hospital  dis- 
charge records,  birth  and  death  cer- 
tificates, end  stage  renal  disease  data, 
and  use  of  national  health  surveys.  It 
was  produced  by  the  Health  Statis- 
tics Section  and  the  Chronic  Disease 
Section  of  the  health  department. 
This  250+  page  report  is  the  most 
thorough  study  to  date  of  diabetes  in 
Colorado  and  was  undertaken  to 
identify  patterns  that  may  suggest 
clues  to  the  causes  or  prevention  of 
the  complications  of  diabetes.  It  in- 
cludes data  by  age,  gender,  race, 
ethnicity  and  county,  where  pos- 
sible. It  was  funded  by  the  federal 
Centers  for  Disease  Control  and  Pre- 
vention. 


Highlights  of  the  study:  An  esti- 
mated 82,000  Coloradans  have  been 
diagnosed  with  diabetes.  Persons 
aged  64-74  and  Hispanics  have  the 
highest  prevalence  rates  (see  Figure 
1,  following  page).  (The  study  did 
not  include  persons  in  nursing 
homes  and  military  hospitals,  so 
rates  among  the  elderly  over  74 
could  be  higher.)  Counties  with  the 
highest  rates  include  those  in  south 
central  and  southeastern  Colorado; 
Adams,  Lake  and  Denver  counties. 

• In  1 990,  one  of  every  six  persons 
with  diabetes  was  hospitalized  at 
least  once.  Diabetes  was  the 
primary  reason  for  14  percent  of 
hospital  stays  and  a secondary 
diagnosis  in  the  rest. 

• Cardiovascular  disease  is  the 
leading  cause  of  hospitalization 
for  persons  with  diabetes. 

• Diabetes  is  responsible  for  55 
percent  of  all  non-trauma-  related 
lower  extremity  amputations 
Colorado.  Each  year  between 

1 989  and  1991,  an  average  of 
384  such  amputations  were 
performed  on  Colorado  residents. 
About  50  percent  were  toe 
amputations. 

• Diabetic  ketoacidosis  was  listed 
on  2,965  (5  percent)  of  all  1989- 
91  Colorado  hospital  discharge 
records  that  listed  diabetes  as  any 
diagnosis. 

• Diabetes  caused  41  percent  of 
new  cases  of  treated  end-  stage 
renal  disease  in  1989  in  Colo- 
rado. The  number  of  people  who 
needed  treatment  almost  qua- 
drupled between  1982  and  1989 
with  the  greatest  increase  in 
persons  over  age  65,  blacks  and 
Hispanics. 

• An  estimated  1 77  diabetic 
persons  became  blind  in  1989. 


• Between  1 989  and  1 991 , an 
average  of  1 22  births  were 
complicated  by  pre-existing 
diabetes  and  857  by  gestational 
diabetes  in  the  mother. 

Persons  with  diabetes  have  2-to- 
3 times  higher  health  care  costs. 
Average  annual  outlays  were  $4,300 
per  person  in  1990.  In  1990,  the 
total  estimated  cost  associated  with 
diabetes  in  Colorado  was  $351 
million  (see  Figure  2 , following 
page).  Direct  costs  were  responsible 
for  43.9  percent  of  the  total  and 
indirect  costs  for  56.1  percent . In- 
patient hospitalization  (which  cost 
$171  million)  was  responsible  for  the 
greatest  proportion  of  direct  costs. 

The  Colorado  Diabetes  Advisor 
Council: 

The  Colorado  Board  of  Health 
created  the  Colorado  Diabetes 
Advisory  Council  in  August  of  1 990. 
The  state  health  department  is 
actively  involved  in  supporting  this 
group.  The  Council  developed  a 
state  plan  which  calls  for  improved 
access  to  care  (including  health 
insurance  and/or  services  for  the 
uninsured  and  better  insurance 
coverage  for  diabetes-related  needs) 
and  more  diabetes  education  for 
those  with  the  disease,  their  families 
and  friends  and  health  care  provid- 
ers. 

For  a free  copy  of  the  report,  the 
state  plan  or  information  about  the 
work  of  the  Diabetes  Advisory 
Council,  call  the  Diabetes  Control 
Program  of  the  Colorado  Department 
of  Health  at  (3G3)-692-2580. 


318 


Colorado  Medicine  for  September,  1993 


Figure  1.  Age-Adjusted  Incidence  Rate  of  End-Stage  Renal  Disease  Treatment  Related  to 
Diabetes,  by  Race/Ethnicity  and  Year:  Colorado  Residents  with  Diabetes,  1982-1989 


Rate  per  100,000  Population 
with  Diabetes 


"O' Total  A White  X Hispanic  & Black 


Age  Adjusted  Incidence  Rate  of  End-Stage  Renal  Disease  Treatment  Related  to 
diabetes,  by  race/ethnicity  and  Year:  Colorado  Residents  with  Diabetes,  1982-1989 

NOTE:  Rates  are  age-adjusted  to  the  estimated  1980  U.S.  population  with  diabetes. 
The  combined  eight-year  age-adjusted  incidence  of  ESRD-DM  per  100,000  Colorado 
diabetic  population  in  1 982-1 989  was  1 1 6 in  whites,  209  in  Hispanics,  and  330  in 
blacks  . This  indicates  that,  in  Colorado,  the  incidence  of  ESRD-DM  per  diabetic 
population  was  1 .8  and  2.8  times  higher,  respectively,  in  Hispanics  and  blacks 
compared  with  whites. These  race/ethnic  differences  were  statistically  significant. 

Figure  2.  Total  Direct  and  Indirect  Costs  Associated  with  Diabetes:  Colorado 
Residents  in  1990. 


The  total  economic  cost  of  diabetes  in  Colorado  was  estimated  to  be  $351  million  in 
1 990.  Direct  costs  totaled  $ 1 54  million  and  comprised  43.9%  of  the  total  costs 
associated  with  diabetes.  Indirect  costs  made  up  56.1  % ($197  million)  of  the  total 
costs  (Figure  2).  In-patient  stays  in  acute  care  hospitals  accounted  for  the  greatest 
proportion  (33%  or  $1 14  million)  of  total  costs,  followed  by  premature  death,  long- 
term disability,  outpatient  care,  nursing  home  care,  and  short-term  morbidity. 


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Colorado  Medicine  for  September,  1993 


319 


Clinical  Practice  Guidelines? 

by  Ted  Lewis , M.D. 
Penrose  - St.  Francis  Hospital 
Colorado  Springs , Colorado 


" The  purpose  of  these 
standards , these  clinical 
guidelines , should  be  to 
improve  patient  outcomes 
by  making  physician 
behavior  more 
appropriate  ..." 


Reprinted  with  permission  from 
the  Penrose  - St.  Francis  Hospital 

"Medical  Staff  Monthly" 


A recent  nationwide  poll  on 
quality  of  service  rated  supermarkets 
first,  airlines  second,  restaurants 
third,  healthcare  fourth  and  automo- 
bile repair  shops  fifth.  This  somewhat 
disturbing  information  (to  physicians 
and  hospital  administrators  alike) 
reveals  continuing  problems  in  the 
American  healthcare  system  to  deli- 
ver quality  service  at  a reasonable 
price.  Quality  care  was  recently  de- 
fined as  that  care  that  has  the 
capacity  to  achieve  goals  of  both  the 
patient  and  physician." 

The  quality  tripod  includes 
Continuous  Quality  Improvement 
(CQI),  guidelines  and  standards,  and 
outcomes  management.  The  most 
controversial  of  these  has  been  the 
guidelines  or  practice  parameters 
movement. 

Setting  standards  or  guidelines  for 
medical  care  is  not  new,  having  first 
been  practiced  and  promoted  by 
Hippocrates.  Physicians  use  practice 
guidelines  as  part  of  their  normal 
daily  practice  of  medicine  based 
upon  their  medical  education,  clin- 
ical training  and  experience.  How- 
ever, because  of  the  wide  variation 
in  evaluating  clinical  outcomes, 
increasing  outside  pressures  are 
being  placed  upon  the  medical  pro- 
fession to  develop  standards  of  prac- 
tice or  clinical  guidelines  so  that 
outcomes  may  be  assessed. 

There  are  five  main  forces 
pushing  us  toward  the  development 
of  practice  guidelines.  The  first 
centers  on  the  increased  financial 
pressures  on  the  healthcare  system. 
The  second  force  is  the  rapidity  of 
the  development  of  new  technology. 
This  technological  explosion  is  not 
only  concerned  with  complex, 
expensive  machines,  but  also 
involves  the  emergence  of  informa- 


tional sciences  and  the  adoption  of 
decision  — analytical  techniques  by 
clinicians.  The  third  is  driven  by  new 
data  showing  significant  levels  of 
inappropriate  care  with  the  waste  of 
billions  of  dollars  of  resources. 

The  fourth  force  is  the  develop- 
ment of  active  management  tools 
designed  specifically  for  quality 
assurance,  utilization  review  and 
cost  containment  efforts.  Thus  pay- 
ers, insurors  and  government  may 
develop  their  own  payment  policies 
based  upon  performance  in  using 
practice  guidelines. 

The  fifth  force  is  being  driven  by 
JCAHO  and  its  Agenda  for  Change 
with  significant  changes  in  the 
standards  for  hospitals  and  other 
healthcare  organizations.  The  em- 
phasis on  quality  of  care  and  process 
is  requiring  new  approaches  and 
techniques  to  assure  compliance 
with  the  JCAHO  standards  by  1994. 
CQI  is  being  pushed  as  the  method 
to  achieve  those  goals  set  by  the 
JCAHO  and  requires  the  collection 
of  reliable,  clinical  data  that  can  be 
interpreted  by  the  use  of  generally 
accepted  clinical  guidelines  and 
standards. 

Many  groups  within  organized 
medicine,  including  the  American 
Medical  Association,  the  American 
College  of  Surgeons,  the  American 
College  of  Physicians,  and  many 
specialty  societies  are  reacting  to 
these  forces.  The  ACP  recognizes 
that  "The  purpose  of  these  standards, 
these  clinical  guidelines,  should  be 
to  improve  patient  outcomes  by 
making  physician  behavior  more 
appropriate  and  based  more  on 
excellence  and  less  on  habit"  (Ball, 
1989). 


320 


Colorado  Medicine  for  September,  1993 


Advice  from  AMA  on 
Response  to  Data  Bank 
Self-Query  Requests 

(Note:  Resolution  #804,  adopted  by 
the  AMA  house  of  Delegates  in  June, 
calls  on  the  AMA  to  distribute 
information  on  the  issues  involved  in 
self-querying  the  National  Practitio- 
ner Data  Bank  on  behalf  of  entities 
which  are  not  otherwise  authorized 
to  receive  that  information,  and  to 
inform  members  that  entities  who  are 
authorized  to  query  the  Data  Bank 
should  not  request  physicians  to  self- 
query on  the  entities'  behalf.  The 
following  material  is  contained  in  a 
memo  from  AMA  Executive  Vice 
President  James  S.  Todd,  MD,  to 
executive  directors  of  state,  county, 
and  national  medical  specialty 
societies.  Dated  May  1 1,  the  title  of 
the  memo  is:  Access  to  National 
Practitioner  Data  Bank  "Self-Query" 
Reports.) 


Me 


The  federal  Health  Care  Quality 
Improvement  Act  of  1 986  created 
the  National  Practitioner  Data  Bank 
(Data  Bank)  which  serves  as  a 
national  repository  for  information 
related  to  licensure  actions,  clinical 
privilege  actions,  and  society 
membership  actions  as  related  to  the 
professional  conduct  and  compe- 
tence of  physicians,  as  well  as 
information  regarding  payment  of 
medical  malpractice  claims.  The 
information  contained  in  the  Data 
Bank  is  confidential  and  is  intended 
only  for  release  to,  and  use  by, 
"authorized"  entities.  The  federal 
law  defines  authorized  entities  as 
health  care  entities  that  (1)  provide 
health  care  services,  and  (2)  engage 
in  formal  peer  review.  Only  such 
entities  may  query,  or  have  access 
to,  the  Data  Bank. 

Last  December,  the  American 
Medical  Association  (AMA)  House  of 
Delegates  adopted  Board  of  Trustees 
Report  L (1-92)  entitled  "Access  to 
National  Practitioner  Data  Bank 
'Self-Query'  Reports."  Board  of 
Trustees  Report  L discusses  the 
AMA's  long-standing  concerns  that 
unauthorized  entities  are  attempting 
to  circumvent  their  inability  to  query 
the  Data  Bank  by  requiring  that  a 
physician  "self-query,"  that 
is,  obtain  from  the  Data  Bank  a copy 
of  his  or  her  own  Data  Bank  report. 
The  physician  is  then  required  to 
submit  the  report  to  the  unauthorized 
entity. 

Physicians  have  been  increas- 
ingly subject  to  pressure  to  self-query 
and  disclose  their  Data  Bank  reports 
to  unauthorized  entities,  predomi- 
nantly preferred  provider  organiza- 
tions and  other  managed  care  plans, 


as  well  as  some  medical  liability 
insurers.  This  situation  presents 
potentially  serious  problems,  espe- 
cially with  regard  to  the  issue  of 
confidentiality. 

It  is  presently  unclear  whether, 
under  federal  law,  Data  Bank  reports 
that  are  "redisclosed"  by  physicians 
to  unauthorized  entities  maintain 
confidentiality  under  the  law;  this 
issue  is  crucial  because  of  the  highly 
sensitive  nature  of  information 
contained  in  the  Data  Bank. 

Further,  federal  law  does  not 
prohibit  entities  from  redisclosing 
Data  Bank  reports  if  "authorized  by 
state  law."  As  it  is  unclear  how  this 
exception  to  the  confidentiality 
provisions  will  be  interpreted, 
physicians  should  submit  Data  Bank 
reports  only  to  entities  that  are 
prohibited,  generally  under  state 
peer  review  laws,  from  further 
redisclosing  the  information. 

The  AMA  has  pursued  this  issue 
with  the  appropriate  federal  agen- 
cies. Amended  Board  of  Trustees 
Report  QQ  (A-92),  adopted  by  the 
House  of  Delegates,  requests,  among 
other  matters,  that  the  AMA  request 
that  the  Health  Resources  and 
Services  Administration  (HRSA),  the 
Federal  agency  responsible  to  the 
administration  of  the  Data  Bank, 
implement  appropriate  steps  to 
ensure  and  maintain  the  confidenti- 
ality of  physician's  self-query  reports. 
The  response  of  Fitzhugh  Mullan, 
MD,  Director,  Bureau  of  Health 
Professions,  to  the  AMA's  request 
was  disappointing.  He  stated  that 
the  Health  Care  Quality  Improve- 
ment Act  "simply  does  not  give  us 
i the  authority  to  regulate  this  prac- 
j tice."  As  recently  as  March,  the 


Colorado  Medicine  for  September,  1993 


321 


AMA  again  communicated  its 
concerns  to  HRSA  regarding  self- 
query issues,  and  submitted  the 
recommendations  made  in  BOT 
Report  L for  comment.  Dr.  Mullan 
has  informed  us  that  the  Office  of  the 
General  Counsel  of  the  Department 
of  Health  and  Human  Services  will 
respond  to  the  AMA's  concerns. 

In  the  interim,  based  upon  the 
fact  that  the  law  is  unclear  with 
regard  to  confidentiality,  and  follow- 
ing the  lead  of  the  California  Medical 
Association,  the  AMA  recommends, 
pursuant  to  BOT  Report  L,  that 
physicians  who  release  Data  Bank 
information  to  unauthorized  entities 
require  such  entities  to  provide  them 
with  the  following  written  documen- 
tation: 

• that  the  requirement  that  the 
physician  self-query  the  Data 
Bank  and  disclose  the  informa- 
tion to  the  entity  is  in  compli- 
ance with  the  intent  and  statu- 
tory protections  of  the  Health 
Care  Quality  Improvement  Act; 


• that  the  information  disclosed  to 
the  entity  will  be  protected  from 
further  disclosure  under  the 
relevant  state  peer  review 
immunity  statute(s); 

• that  the  information  will  be 
used  only  for  and  maintained 
only  for  those  purposes,  such  as 
quality  assurance  activities,  that 
are  protected  under  the  relevant 
state  peer  review  immunity 
statute(s); 

• that  the  entity  will  protect  the 
confidentiality  of  the  information 
to  the  fullest  extent  permitted  by 
both  state  law  and  the  Health 
Care  Quality  Improvement  Act. 
BOT  Report  L also  provides  that 

until  legislation  is  enacted  making  it 
illegal  for  any  practitioner  to  be 
required  to  submit  a copy  of  his  file 
report  from  the  Data  Bank  to  any 
entity  or  agency,  that  the  AMA 
provide  model  language  that  physi- 
cians can  use  to  protect  confidential- 
ity when  they  release  their  Data 
Bank  report  to  entities  not  autho- 
rized to  access  the  Data  Bank. 


Pursuant  to  BOT  Report  L,  we 
have  prepared  the  attached  sample 
letter,  which  can  be  used  by  your 
members  if  they  are  required  to 
submit  a copy  of  their  Data  Bank 
report  to  unauthorized  entities.  If  we 
are  given  assurances  from  any 
Federal  agency  that  the  confidential- 
ity of  information  is  preserved  even  if 
physicians  submit  it  to  unauthorized 
agencies,  we  will  so  advise  you. 

Finally,  BOT  Report  L also 
specifies  that  the  AMA  urge  state  and 
county  medical  societies  to  develop 
a mechanism  physicians  can  use  to 
report  problems  they  encounter  with 
these  entities.  Such  mechanisms  will 
serve  to  strengthen  our  mutual  efforts 
to  protect  our  members. 

We  ask  that  you  take  action  to  put  a 
mechanism  into  place  immediately, 
and  to  encourage  your  members  to 
report  problems  to  you. 

If  you  need  any  further  informa- 
tion, please  contact  Michael  Vitek, 
Director,  Department  of  Hospital 
Medical  Staff  Services,  American 
Medical  Association,  at  (312)  464- 
4757. 


Sample  Letter: 


Dear: 

You  have  requested  that  I "self-query"  the  National  Practitioner  Data  Bank  (Data  Bank)  and  provide  a copy 
of  my  Data  Bank  report  to  you. 

You  are  no  doubt  aware  that  the  information  contained  in  the  Data  Bank  is  confidential  and  is  intended  for  use 
only  by  those  entities  that  are  "authorized"  under  the  federal  Health  Care  Quality  Improvement  Act  of  1986, 
the  law  that  created  the  Data  Bank.  The  federal  law  defines  authorized  entities  as  health  care  entities  that  (1) 
provide  health  care  service,  and  (2)  engage  in  formal  peer  review. 

It  is  presently  unclear  whether  the  confidentiality  provisions  of  the  federal  law  and  the  accompanying 
regulations  continue  to  apply  to  Data  Bank  reports  that  are  disseminated  by  a physician  to  an  unauthorized 
entity.  Because  of  the  highly  sensitive  nature  of  the  information  contained  in  the  Data  Bank,  I will  require,  prior 
to  submitting  any  information  to  you,  written  documentation  from  your  organization  that  responds  to  each  and 
every  one  of  the  following  issues: 

1 . That  the  requirement  that  I self-query  the  Data  Bank  and  disclose  the  information  to  you  is  in  compliance 

with  the  intent  and  statutory  protections  of  the  Health  Care  Quality  Improvement  Act  of  1 986. 

2.  That  the  information  disclosed  to  you  will  be  protected  from  further  disclosure  under  the  relevant  state  peer 

review  immunity  statute(s). 

3.  That  the  information  will  be  used  only  for  and  maintained  only  for  those  purposes,  such  as  quality  assur- 

ance activities,  that  are  protected  under  the  relevant  state  peer  review  immunity  statute(s). 

4.  That  your  organization  will  protect  the  confidentiality  of  the  information  to  the  fullest  extent  permitted  by 

both  state  law  and  the  Health  Care  Quality  Improvement  Act. 

Unless  your  organization  can  comply  with  these  requests,  please  be  advised  that  1 cannot  submit  any 
information  received  by  the  Data  Bank  to  you. 

Very  truly  yours, 


322 


Colorado  Medicine  for  September,  1993 


New  Information 
Service 

Denison  Memorial  Library  at  the 
University  of  Colorado  Health 
Sciences  Center  has  announced  a 
new  service  that  should  be  especially 
helpful  to  physicians  in  outlying 
areas  or  those  with  limited  time  for 
research.  It  is  called  Information 
Express  Delivery  Services  (IEDS)  and 
offers  to  supply  photocopies  of 
journal  articles  and  book  chapters  to 
physicians.  If  they  don't  have  the 
material  in  their  library,  they  will 
locate  and  obtain  it. 

Requests  may  be  made  by 
phone,  fax,  mail  or  on-line  through 
Internet  or  CU-MEDLINE/Paper- 
Chase.  The  requested  articles  or 
chapters  are  delivered  by  mail,  fax 
(@  50tf  per  page)  or  you  may  pick 
them  up  at  the  library.  Payment  for 
orders  delivered  by  fax  may  be  made 
by  cash,  check,  Visa,  MasterCard  or 
Deposit  Account.  For  mail  or  pickup 
there  is  no  charge.  For  more  informa- 
tion, call  Yvette  Ferree  at  (303)  270- 
5595. 

Colo.  Physicians 
Caring  in  Other 
Countries 

In  the  past  year,  Colorado 
Medicine  has  reported  on  various 
humanitarian  efforts  performed  by 
Colorado  Medical  Society  members. 
These  reports  have  spotlighted 
medical  teams  traveling  in  Vietnam, 
Mexico  and  Costa  Rica. 

The  Colorado  Medical  Society 
recently,  became  aware  of  the 
Brooke  Foundation.  They  are  the 


Medical 


primary  American  contributor  of 
ongoing  developmental  programs 
aimed  at  rehabilitating  the  Romanian 
Child  care  System.  Directed  by 
James  Bascom,  MD.  and  Barbara 
Bascom,  MD,  the  Brooke  Foundation 
is  headquartered  in  Washington,  DC 
as  well  as  Bucharest,  Romania. 

The  primary  mission  of  the 
Orthopedic  Teaching  Team  Effort- 
Roman  ia  or  (OTTER)  program  is  to 
determine  the  current  knowledge 
base  and  clinical  practice  skills  in 
child  development  and  to  determine 
the  educational  needs  for  institu- 
tional staff  and  professionals-in- 
training. 

OTTER  program  will  make  four 
trips  to  Bucharest,  Romania  this  year. 
The  medical  team  consists  of  1 6 
members,  7 being  members  of  the 
Colorado  Medical  Society.  The 
Brooke  Foundation  is  currently 
looking  for  individuals  to  travel  and 
teach  in  Romania.  For  more  informa- 
tion contact;  Dr.  Reiner  G.  Kremer  at 


7601  E.  Burning  Tree  Dr.,  Frank- 
town,  CO.  801 1 6,  Phone:  688-1  111. 

Get  Acquainted 
with  Medical 
Informatics 

The  Denver  Medical  Library  will  host 
the  first  Medical  Informatics  Fair  at 
the  Presbyterian  St.  Luke's  Medical 
Center  in  Denver  on  September  27 
and  28.  This  is  to  commemorate  the 
one  hundredth  anniversary  of  the 
Denver  Medical  Library  housed  at  P/ 
SL. 

In  addition  to  informational 
events,  such  as  the  presentation 
Computers  in  Medicine,  vendors  will 
display  their  systems  and  answer 
questions  from  1 1 am  to  7:30  pm 
both  days. 

For  more  information  call  the 
Denver  Medical  Library  at  839-6670. 
They  are  located  at  1719  East  1 9th 
Street  in  Denver. 


Donald  J.  Northey,  M.A. 

Clinical  Audiology 
Audiological  Consultants,  Inc. 

• General  Audiology 
• Hearing  aid  evaluations 
• Hearing  aid  dispensing,  service  and  aftercare 
• Amplified  stethoscopes 
• Noise,  swim  and  surgical  ear  plugs 
• Electronic  Shooters  Protection 
ENGLEWOOD  LAKEWOOD 

3575  S.  Sherman  St.,  Suite  #2  2020  Wadsworth,  #4 

761-7600  238-1366 

Providing  a rewarding  hearing  aid  experience  since  1970. 


Colorado  Medicine  for  September,  1993 


323 


New  members 


ARAPAHOE  MEDICAL  SOCIETY 

Gregory  A Arfsten,  MD 
7373  W Jefferson  Ave  #102 
Lakewood,  CO  80235 
Elected  07/20/93 

James  L Benoist,  MD 
701  E Hampden  Ave  #330 
Englewood,  CO  801 1 0 
Elected  04/20/93 

Stephen  M Crusey,  MD 
333  W Hampden  Ave  #600 
Englewood,  CO  801 1 0 
Elected  06/1  5/93 

George  A Frey,  MD 
850  E Harvard  Ave  #1  55 
Denver,  CO  80210 
Elected  05/20/93 

Lindy  S Gilchrist,  MD 
8200  E Belleview  Ave  #280 
Englewood,  CO  801 1 1 
Elected  12/08/92 

David  M Gonzalez,  MD 
601  E Hampden  Ave  #460 
Englewood,  CO  801 10 
Elected  05/20/93 

Robert  J Hass,  MD 
333  W Hampden  Ave  #600 
Englewood,  CO  801 10 
Elected  02/01/93 

Michael  W Hutchins,  MD 
333  W Hampden  Ave  #600 
Englewood,  CO  801 1 0 
Elected  07/20/93 

John  P Jacobs,  MD 
799  E EHampden  Ave  #1 00 
Englewood,  CO  801 10 
Elected  07/01/93 

Eric  A Kalhoefer,  MD 
333  W Hampden  Ave  #600 
Englewood,  CO  801 10 
Elected  05/20/93 

Richard  M Liles,  MD 
333  W Hampden  Ave  #600 
Englewood,  CO  801 1 0 
Elected  05/20/93 


James  W Martin,  MD 
206  W County  Line  Rd  #210 
Highlands  Ranch,  CO  80126 
Elected  04/20/93 

Wayne  L Peters,  MD 
5889  Greenwood  Plaz  Blvd  #200 
Englewood,  CO  801 1 1 
Elected  07/20/93 

Erin  C Prenger,  DO 
3333  S Bannock  St  #600 
Englewood,  CO  80110 
Elected  07/20/93 

Eugenia  H Pritchett,  MD 
4070  S Holly  St 
Englewood,  CO  801 1 1 
Elected  06/1 5/93 

Bruce  W Smith,  MD 
3290  S Wadsworth  Blvd 
Lakewood,  CO  80227 
Elected  07/20/93 

Jean  M Taguiam,  MD 
333  W Hampden  Ave  #600 
Englewood,  CO  801 1 0 
Elected  07/20/93 

Marcella  L Thiel,  MD 
200  W County  Line  Rd  #1 50 
Highlands  Ranch,  CO  80126 
Elected  04/20/93 

Richard  W Weber,  MD 
5579  S Hanover  Way 
Englewood,  CO  801 1 1 
Elected  06/1 5/93 

Paul  Zelenkov,  MD 
333  W Hampden  Ave  #300 
Englewood,  CO  801 10 
Elected  05/20/93 


AURORA-ADAMS  COUNTY 
MEDICAL  SOCIETY 

Timothy  D Colander,  MD 
14100  E Arapahoe  Rd  #270 
Englewood,  CO  801 1 2 
Elected  06/1 5/93 


Ira  G Early  Jr,  MD 

FAMC 

Bldg  409 

Aurora,  CO  80045 
Elected  03/31/93 

Erin  A Madden,  MD 
1 421  S Potomac  St  #320 
Aurora,  CO  8001 2 
Elected  06/30/93 

Jeffrey  Siegel,  MD 
730  Potomac  St  #1 1 8 
Aurora,  CO  8001 1 
Elected  07/01/93 

Yin  C Woo,  MD 
1 577  Havana  St 
Aurora,  CO  80010 
Elected  07/01/93 

BOULDER  COUNTY  MEDICAL 
SOCIETY 

Gloria  P Bachelder,  MD 
877  S Boulder  Rd 
Louisville,  CO  80027 
Elected  04/04/93 

Eileen  M Fish,  MD 
2880  Folsom  St  #110 
Boulder,  CO  80304 
Elected  05/06/93 

Paul  M Hendricks,  MD 
1 600  28th  St  #262 
Boulder,  CO  80301 
Elected  04/04/93 

Joel  S Meyers,  MD 
1446  Hover  Rd 
Longmont,  CO  80501 
Elected  02/1 8/93 


CLEAR  CREEK  VALLEY  MEDICAL 
SOCIETY 

Cathleen  M Abbott,  MD 
8805  W 14th  Ave  #110 
Lakewood,  CO  80215 
Elected  07/27/93 

Clinton  M Anderson,  MD 
8380  N Zuni  St  #100 
Denver,  CO  80221 
Elected  07/08/93 


324 


Colorado  Medicine  for  September,  1993 


New  members 


Kimberlee  1 Barnes,  MD 

Stefon  G Pribil,  MD 

Janet  O Dehler,  MD 

8400  Alcott  St  #103 

4200  W Conejos  PI  #105 

924-B  Milo  Cir 

Westminster,  CO  80030 

Denver,  CO  80204 

Lafayette,  CO  80026 

Elected  04/1  5/93 

Elected  12/01/92 

Elected  06/01/93 

Kenneth  R Cohen,  MD 

Leif  A Redal,  MD 

Jose  deLeon,  MD 

333  S Allison  Pkwy 

9950  W 80th  Ave  #15 

300  Cook  St 

Lakewood,  CO  80226 

Arvada,  CO  80005 

Denver,  CO  80206 

Elected  04/1  5/93 

Elected  12/01/92 

Elected  06/01/93 

Matthew  T deKay,  MD 

Bruce  E Walker,  MD 

Terry  Dunn,  MD 

17601  S Golden  Rd 

4200  W Conejos  PI  #402 

777  Bannock  St 

Golden,  CO  80401 

Denver,  CO  80204 

Denver,  CO  80204 

Elected  07/27/93 

Elected  07/01/93 

Elected  04/01/93 

Nita  M Desai,  MD 

CURECANTI  MEDICAL  SOCIETY 

Garret  M Gannuch,  MD 

4375  Wadsworth  Blvd 

William  H Leyva,  MD 

PO  Box  18289 

Wheat  Ridge,  CO  80033 

815  S 3rd  St 

Denver,  CO  80218 

Elected  01/19/93 

Montrose,  CO  81401 
Elected  04/16/93 

Elected  07/01/93 

Cynthia  L Elliott,  MD 

David  H Garfield,  MD 

8300  W 38th  Ave 

Lars  A Stangebye,  MD 

2005  Franklin  St  #150 

Emer  Dept 

816  S 5th  St 

Denver,  CO  80205 

Wheat  Ridge,  CO  80033 

Montrose,  CO  81 401 

Elected  07/1  3/93 

Elected  06/30/93 

Elected  04/1 6/93 

Gaia  Georgopoulos,  MD 

James  S Gebhard,  MD 

DENVER  MEDICAL  SOCIETY 

6979  S Holly  Cir  #275 

1 805  Kipling  St 

Bruce  Blyth,  MD 

Englewood,  CO  801 1 2 

Lakewood,  CO  80215 

1601  E 19th  Ave  #3750 

Elected  05/01/93 

Elected  04/1 3/93 

Denver,  CO  80218 

Elected  0 

Deborah  C Greenwall,  MD 

Andrew  M Johanos,  MD 

1601  E 19th  Ave  #6600 

1 069  Cook  St 

Brent  M Cohen,  MD 

Denver,  CO  80218 

Denver,  CO  80206 

4545  E 9th  Ave  #670 

Elected  06/01/93 

Elected  07/01/93 

Denver,  CO  80220 

Elected  06/01/93 

Gary  W Jay,  MD 

Steve  R Krebs,  MD 

1 01 90  Bannock  St  #1 30 

4350  Wadsworth  Blvd  #350 

Hal  D Cohn,  MD 

Northglenn,  CO  80221 

Wheat  Ridge,  CO  80033 

7484  E Warren  Dr  #104 

Elected  04/01/93 

Elected  07/01/93 

Denver,  CO  80231 

Elected  05/01/93 

Jessica  M Johnson,  MD 

Nalin  J Mehta,  MD 

520  S High  St 

4200  W Conejos  PI  #136 

Susanna  Coiro,  MD 

Denver,  CO  80209 

Denver,  CO  80204 

8018  W 78th  Cir 

Elected  07/01/93 

Elected  04/26/93 

Arvada,  CO  80005 

Elected  05/01/93 

Thomas  SM  Patterson,  MD 

Isaac  Melamed,  MD 

8162  W 90th  Ave 

1895  Wadsworth  Blvd 

Bonnie  A Coyne,  MD 

Westminster,  CO  80021 

Lakewood,  CO  80215 

777  Bannock  St 

Elected  05/01/93 

Elected  06/08/93 

Denver,  CO  80204 

Elected  04/01/93 

Khoi  D Pham,  MD 

Malcolm  O Perry,  MD 

210  University  Blve 

4200  W Conejo  PI  #310 

Denver,  CO  80206 

Denver,  CO  80204 
Elected  07/01/93 

Elected  06/01/93 

Colorado  Medicine  for  September,  1993 


New  members 


Irina  Pines,  MD 
1255  S Bell  a i re  St  #209 
Denver,  CO  80222 
Elected  05/01/93 

Christopher  Roberts,  MD 
3965  E Florida  Ave  #5-106 
Denver,  CO  80210 
Elected  07/01/93 

Stephen  H Shealy,  MD 
3665  Cherry  Creek  N Dr  #350 
Denver,  CO  80209 
Elected  06/01/93 


Clay  B Carr  III,  MD 
31 1 N Union  Blvd 
Colorado  Springs,  CO  80909 
Elected  03/24/93 

Gordon  R Golden,  MD 
5955  Lehman  Dr 
Colorado  Springs,  CO  80918 
Elected  05/1  2/93 

Robert  A Hannaman,  MD 
2639  Sunnywood  Ave 
Woodland  Park,  CO  80863 
Elected  04/21/93 


LA  PLATA  COUNTY  MEDICAL 
SOCIETY 

Jo  B Fletcher,  MD 
1628  Walnut  St 
Boulder,  CO  80302 
Elected  06/30/93 

MEDICAL  STUDENT  COMPONENT 
MEDICAL  SOCIETY 

James  A Frank 
880  Cherry  St  #40 7 
Denver,  CO  80220 
Elected  05/29/93 


Martha  S Sheiner,  MD 
3535  Cherry  Creek  N Dr  #406 
Denver,  CO  80209 
Elected  02/01/93 


Lon  A Hayne,  MD 
1625  Medical  Ctr  Point 
Colorado  Springs,  CO  80907 
Elected  04/21/93 


Charles  E Wilson 
14084  N 95th  St 
Longmont,  CO  80501 
Elected  05/1  5/93 


Elena  Shissel,  MD 
1039  S Parker  Rd  #F-7 
Denver,  CO  80231 
Elected  08/01/93 

Shashikala  Varma,  MBBS 
825  Dahlia  St  #408 
Denver,  CO  80220 
Elected  05/01/93 

Catherine  A Verhille,  MD 
2045  Franklin  St 
Denver,  CO  80205 
Elected  07/01/93 

EL  PASO  COUNTY  MEDICAL 
SOCIETY 

James  D Albert,  MD 
1 725  Boulder  St  #1 04 
Colorado  Springs,  CO  80909 
Elected  07/21/93 

Michael  J Barber  MD,  PHD 
25  E Jackson  St  #301 
Colorado  Springs,  CO  80907 
Elected  07/21/93 

Peter  Bianco,  DO 
6285  Lehman  Dr  #200 
Colorado  Springs,  CO  80918 
Elected  04/1  5/93 


Evelyn  K McDivitt,  MD 
31 1 N Union  Blvd 
Colorado  Springs,  CO  80909 
Elected  05/19/93 

Jeffrey  C Patterson,  DO 
2131  N Tejon  St  #L-3 
Colorado  Springs,  CO  80907 
Elected  02/22/93 

Diane  F Ryan,  MD 
3910  S Carefree  Cir  #B 
Colorado  Springs,  CO  8091  7 
Elected  07/21/93 

Mark  Roger  Storm,  MD 
Evans  Army  Comm  Hosp 
Emer  Dept 

Fort  Carson,  CO  8091  3 
Elected  01/20/93 

David  R Wolf,  MD 
555  E Pikes  Peak  Ave  #108 
Colorado  Springs,  CO  80903 
Elected  05/19/93 


INTERMOUNTAIN  MEDICAL 
SOCIETY 

Sandra  J Schorr,  MD 
1 81  W Meadow  Dr 
Vail,  CO  81657 
Elected  07/01/93 


MESA  COUNTY  MEDICAL  SOCIETY 

Bradley  A Baldwin,  DO 
1 060  Orchard  Ave 
Grand  Junction,  CO  81  501 
Elected  03/02/93 

Steven  J Heil,  MD 
550  Patterson  Rd 
Grand  Junction,  CO  81  501 
Elected  09/05/92 

Herbert  S Mooney  III,  MD 
PO  Box  1628 

Grand  function,  CO  81  502 
Elected  05/04/93 

David  L Nock,  DDS 
1 32  Walnut  Ave 
Grand  Junction,  CO  81  501 
Elected  01/05/93 

MT.  SOPRIS  COUNTY  MEDICAL 
SOCIETY 

Morris  Cohen,  MD 
225  N Mill 

Aspen  CO  81 611  920-7024 
Elected  04/01/93 

Joseph  G Costantini,  MD 
PO  Box  6267 
Snowmass,  CO  8161 5 
Elected  06/11/93 


326 


Colorado  Medicine  for  September,  1993 


N 


Elizabeth  L Kulwiec,  MD 
1058  S High  St 
Denver,  CO  80209 
Elected  06/04/93 

Daniel  Olson,  DO 
2853  Cnty  Rd  4 
Meeker,  CO  81 641 
Elected  06/04/93 

Bennie  B Wright  Jr,  MD 
61 1 W Main  St 
Aspen,  CO  8161 1 
Elected  06/01/93 


OTERO  COUNTY  MEDICAL 
SOCIETY 

George  D Smith,  DO 
PO  Box  626 
La  Junta,  CO  81050 
Elected  04/1  2/93 


PUEBLO  COUNTY  MEDICAL 
SOCIETY 

Blair  C Presti,  MD 
1 008  Minnequa  Ave 
Pueblo,  CO  81004 
Elected  0 


WELD  COUNTY  MEDICAL 
SOCIETY 

Russell  B Branum,  MD 
1 900  1 6th  St 
Greeley,  CO  80631 
Elected  03/16/93 

Douglas  B Fullerton,  MD 
1 900  1 6th  St 
Greeley,  CO  80631 
Elected  1 2/04/92 

David  I Tryggestad,  MD 
1900  16th  St 
Greeley,  CO  80631 
Elected  12/04/92 


PHYSICIAN 
FOLLOW  THROUGH 


Yes!  Please  send  me  free  information  on  patient 
medicine  counseling.  (Please  Print) 


t 


Mail  to: 

NCPIE 

666  Eleventh  Street,  NW 
Suite  810 

Washington,  DC  20001 


It’s  the  professional  edge 
in  patient  satisfaction  and 
medicine  compliance. 


Prescribing  the  right  medicine 
isn’t  enough.  It's  important  to 
follow  through  and  explain 
how  and  when  to  take  it, 
precautions  and  side  effects. 

The  National  Council  on 
Patient  Information  and 
Education  (NCPIE)  has  free 
materials  to  help  you  talk 
about  prescriptions. 


Colorado  Medicine  for  September,  1993 


327 


Classified  Advertising 


Publication  of  any  advertisement  in  Colorado  Medicine  is  notan  endorsement  by  the  Colorado  Medical  Society 
of  the  product  or  service.  Colorado  Medicine  magazine  is  the  official  journal  of  the  Colorado  Medical  Society,  and 
is  authorized  to  carry  General  Advertising. 


♦ PROFESSIONAL  OPPORTUNITIES 

BEAUTIFUL  BOULDER,  COLORADO! 
Position  available  for  BE/BC  Family 
Practice  physician  to  join  two  other  MD's 
in  busy  family  practice  setting.  Competitive 
salary  and  excellent  benefits  package  which 
includes  malpractice  insurance  coverage. 
Send  CV  to  K.  Lewis,  office  administrator, 
1 600  28th  St.  Ste.  262,  Boulder,  CO.  80301 , 
c/o  HealthWatch  Medical  Center.  (303) 
444-6400.  1/0893 

AN  EXCELLENT  PRACTICE  OPPOR- 
TUNITY exists  for  a BC/BE  Family  Practice 
physician  to  assume  the  practice  of  retiring 
physician  in  northern  Colorado.  The 
successful  candidate  will  have  immediate 
access  to  an  established  patient  base,  and 
will  affiliate  with  7 physician  Family  Practice 
group  for  call  coverage.  This  is  a solo 
practice  in  LaSalle,  Colorado,  approx- 
imately 50  miles  north  of  Denver  and  an 
hour  from  the  mountains.  An  excellent 
school  system,  modestly  priced  housing,  a 
four  year  University  and  community  col  lege 
are  all  available  locally.  Supporting  hospital 
is  286  bed  regional  medical  center  with 
Family  Practice  residency  program.. 
Competitive  compensation  and  benefits. 
Send  CV  to:  Vicki  Baier,  Director,  Physician 
Support,  North  Colorado  Medical  Center, 
1 801  1 6th  Street,  Greeley,  CO  80631 . 

2/0893 

INTERNAL  MEDICINE  - Colorado  Springs: 
37  Physician  Multi-Specialty  Group  seeking 
BC/BE  primary  care  internist.  FFS/prepaid 
practice.  Send  CV:  Administrator,  Colorado 
Springs  Medical  Center,  P.C.,  209  South 
Nevada  Ave.,  Colorado  Springs,  CO  80903- 
1993  3/0793 

TIRED  OF  THE  DAY  TO  DAY  HASSLE  of 

HMO's,  Medicare,  discounted  insurance 
and  being  on  cal  I (Then  consider  a position 
with  corrections.  Before  you  say  "No  Way," 
call  us  and  find  out  more.  Contact  Roderic 
Gottula,  MD,  10900  Smith  Road,  Denver, 
CO  80239  or  call  (303)  375-21 1 0.6/0793 


AT  LAST!  Colorado  finally  has  a South- 
western owned  and  operated  Physician 
Recruiting  company  that  understands  and 
specializes  only  in  the  Southwest.  Our 
proven  policy  of  friendly,  efficient,  but 
affordable  service  is  now  available  to 
meet  your  Permanent  and  Temporary 
Physician  and  Physician  Assistant  needs. 
We'll  visit  your  clinic,  review  your 
requirements  and  search  for  just  the  right 
person.  All  at  no  cost  to  you!  you  don't 
pay  ifwe  don't  succeed.  Call  ustoday!  1- 
800-  657-0354  or  (602)433-9548,  FAX: 
(602)  433-9548.  3/0893 


EMERGENCY  PHYSICIAN,  Denver,  CO.  F/ 
P Time  BC/BE  EM  or  Primary  Care  w/  ER 
experience.  MarkTalmage,  MD,  (303)  369- 
1 1 46  or  CV  to  Southeast  Denver  Emergency 
Physicians,  PC  875  S.  Colorado  Blvd.  #653, 
Denver,  CO.  80222.  2/0893 

LOCUM  TENENS...  new  adventures,  free 
from  administrative  tasks,  flexibility,  and 
high  earnings.  Assignments  vary:  one  day, 
one  week,  one  month,  long  term,  OR,  time 
off  with  peace  of  mind,  knowing  that  your 
practice  goes  uninterrupted.  Qualified 
physicians  are  ready  to  assist.  Ten  years 
experience;  physician-managed  company. 
Call  INTERIM  PHYSICIANS  today  for 
details.  — Denver  691  -071 8,  or  1 -800-669- 
0718  12/1292 

BOULDER  - Urgent/Family/Occupational 
Medicine  - Successful  Medical  Center 
seekingtwo  BE/BC  physiciansfor  excellent 
opportunity  in  prime  SE  Boulder  area. 
Minimal  call  Flexible  scheduling.  Send  CV 
and  call  Dr.  Turnbow,  Meadows  Medical 
Center,  P.C.,  4800  Baseline,  D-106, 
Boulder,  CO.  80303.  (303)  499-4800. 

4/0893 

PHYSICIANS,  (MD/DO)-  Part-time 
practice,  Denver,  Flight  surgeon,  Disaster 
& Occupational  Medicine.  Expand  your 
horizon  with  the  Air  National  Guard.  Call 
EDD  (307)772-6185.  The  Air  National 
Guard.  9/0293 


♦ SITUATIONS  WANTED 

RN  EXPERIENCED  21  years  same  medical 
office  desires  challenging  medical  office 
position.  Very  flexible  S/E  Denver.  324- 
2927.  3/0993 

♦ PROPERTIES  FOR  SALE  OR  LEASE 

JEWELL  & WADSWORTH-  Retail/office 
space  for  lease  - excellent  exposure  - free 
standing  building -2000  square  feet  $1  375/ 
month.  Tenant  finish  $$  available.  Call 
Billy  Halax  973-1380  6/0593 

MAUI,  HAWAII.  Luxurious  2BR/2BA, 
2,100  sq.  ft.  condominium  in  Kaanapali 
Beach  Resort,  100  yards  from  beach. 
Everything's  new!  Pool,  Jacuzzi,  Sauna, 
Lighted  Tennis  Courts,  Maids.  On  16th 
fairway  of  the  Royal  Kaanapali  Golf  Club. 
Special  Spring/Summer  Rates.  Call  985- 
9531.  6/0393 


CUT  OVERHEAD 

Share  office  space  in  beautiful  modern 
building  with  a great  view.  DTC  location. 
Full  or  part  time,  ideal  for  any  specialty 
except  pediatrics.  A fully  equipped 
surgical  suite  available  on  site.  This  is  an 
excellent  opportunity  to  enjoy  a modern 
well-equipped  facility  at  a reasonable 
cost.  Call  Lisa  - 773-3455  4/0793 


MEDICAL  OFFICE  SPACE  ALREADY  BUILT 
OUT  AND  PAID  FOR.  Save  your  $$$$$'s. 
Greenwood  Village  location;  1 -1/2  blocks 
west  of  l-25/Belleview  interchange,  very 
easy  for  patients  to  find.  3,188  rentable 
square  feet.  Extensive  medical  finishes  and 
upgrades  throughout,  x-ray  machine, 
cabinets,  desks,  phone  system,  all  available 
for  purchase.  Property  managed  on-site- 
Available  for  immediate  occupancy. 
Contact  CB  Commercial  Fairbairn/Ogilvie 
(303)  799-1800. 


328 


Colorado  Medicine  for  September,  1993 


c 


lassified  Advertising 


VAIL  BEAVER  CREEK  SKIING,  Available 
Christmas-New  years.  3 BR.  31/2  bath 
duplex  sleeps  9.  All  amenities  Frpl. 
Convenient  bus  rt.  Call  (303)-845-9347. 
2/0893 

♦ EQUIPMENT  FOR  SALE  OR  LEASE 

PANASONIC  PHONE  SYSTEM-  Perfect  for 
small  medical  office,  PBX  line  auto  attended. 
$3000.00.  Call  465-2323.  2/0893 

BUY  DIRECT— LOCAL  MFGR.  Custom 
Office  Furniture — Desks,  Credenzas, 
bookcases,  Files,  work  stations,  waiting 
room  seating,  etc.  Oak-cherry  & walnut. 
We  build  quality  custom  office  furniture  at 
a price  you  can  afford.  Mark  IV  Systems, 
Inc.  297-1 248.  8:00-4:30  M-F.  1 2/0293 

♦ SERVICES 

EXPERIENCED  MEDICAL  TRANSCRIP- 
TIONIST — Surgery/Clinic  dictation — ENT, 
Gl,  General  Surgery,  Neurology,  OB/GYN, 
Orthopedics/Podiatry,  Rheumatology, 
Pediatrics,  Plastics.  Fast,  accurate  — IBM 
PC,  WP  5.1,  Format/Laser  Print.  Home: 
(303)  329-6572/  FAX:  (303)  329-8266. 

3/0993 

QUICK  CLAIM  ELECTRONIC  CLAIMS 
PROCESSORS,  HMO  PPO,  MEDICARE, 
MEDICAID  AND  PATIENTS  BILLING  (303) 
333-8666.  22/0393 

HOME  MORTGAGE  LOANS 
LOW  DOC  PROGRAM  available  for 
physicians  and  other  health  professionals. 
Purchase  and  refinance.  Call  Milt,  a 
mortgage  banker  with  1 8 years  experience. 
753-6262.  12/1292 

INNOVATIONS  SHOULD  BE  PATENTED 

if  marketable.  For  more  information  call 
Brian  D.  Smith  of  Fields,  Lewis,  Pittenger  & 
Rost.  Colo's  leading  patent  law  firm.  Mr. 
Smith  specializes  in  the  medical  arts.  (303) 
758-8400.  12/1192 


RESIDENTIAL  REAL  ESTATE  SALES.  Dealing 
in  homes  valued  above  $250,000.  1 2 yrs. 
exper.  BS:  Real  Estate  and  Construction 
Mgmt-D.U.  MS:  Finance  & Tax  - C.U. 
Steven  Carter,  Pres.  Flatiron  RE  Serv. 
Denver/Boulder  (303)888-0521  1 2/0893 

If  the  objective  is  financial  independence. . . 
there  is  another  way...  Outsourcing 
through  Clinic  Service  Corporation. 
Established  in  1974  simply  as  a billing 
service,  today  we  offer  Colorado's  most 
extensive  practice  management  package. 
Expandable,  CSC  systems  grow  to  meet 
your  demands.  For  more  information  and 
references  please  call  Yvette  Schrock  at 
777-9674.  4/0893 


♦ MISCELLANEOUS 

EQUIPMENT  NEEDED  URGENTLY  for 

large  community  health  center  located  in 
Longmont.  Our  five-exam  room  facility 
will  soon  expand  to  1 2 exam  rooms  and  we 
are  looking  for  good  used  office  equipment 
and  exam  room  furnishings.  Call  to  discuss 
price/donations  with  Mark  Kissack  at  (800) 
388-4325.  6/0393 


PROFESSIONAL  MEDICAL  SPACE 
AVAILABLE  FOR  LEASE  OR  PURCHASE 


• Private  Doctors  Office 

• 6 Exam  Rooms 

• Nurses  & Records  Station 

• Centrally  Located 

• Functional  Reception  Area 


High  Growth  Southeast  Area 
High  Residential  Density 
Exceptional  Access 
Quality  Finish  Throughout 
High  Profile  Street  Signage 


• Divisible  — 1 800  to  3000  sq.  ft.  • Competitive  Rates 

ON  SITE  MANAGEMENT 

Harbor  Pointe  — Parker  Road  and  Quincy  Avenue 
Contact:  Jamie  Harris 

Western  Centers,  Inc 

13731  East  Rice  Place  #105  • Aurora,  Colorado  80015 
(303)  680-5080  • Fax  (303)  680-4488 


Colorado  Medicine  for  September,  1993 


329 


(def:  chewing  again  what  has  been  chewed  slightly  and  swallowed;  to  REFLECT) 


"What  was  most  memo- 
rable about  it  was  hearing 
the  train  whistle  at  night , 
echoing  through  the  val- 
ley... " 


I was  born  in  West  Virginia  not  a 
great  number  of  miles  from  civiliza- 
tion of  that  day,  but  far  enough  that, 
when  I was  very  young,  I remember 
thinking  the  world  was  very  small. 
The  world,  as  I knew  it,  consisted  of 
the  land  and  the  sky,  the  river 
flowing  by,  and  everything  else  in 
the  360°  view  was  it!  That  was  the 
world.  Things  came  and  went  in  my 
world  and  when  I was  old  enough  to 
start  putting  two  and  two  together  I 
began  to  wonder  where  these 
"things"  came  from  and  went  to. 

We  lived  in  a small  town  next  to 
the  river  in  a valley.  Along  the  river 
ran  the  county  road  and  a railroad 
track.  Every  other  day  a passenger 
train  ran  through  town  going  south  , 
seldom  stopping.  On  the  off  days, 
the  train  passed  through  going  north. 
It  stopped  more  often  than  the  south- 
bound. I learned  later  why  that  was. 
What  was  most  memorable  about  it 
was  hearing  the  train  whistle  at 
night,  echoing  through  the  valley, 
and  then  seeing  the  lighted  cars  and 
the  people  inside  doing  any  variety 
of  things.  They  were  in  their  own 
world,  and  their  world  and  my  world 
only  brushed  briefly  against  one 
another;  their  worlds  passed  through 
my  space  but  never  interfered  with 
my  life. 

I remember  wondering  where 
the  people  came  from  and  where 
they  were  going.  Seeds  of  curiosity. 
They  probably  came  from  the  same 
mysterious  places  I heard  about  on 
my  brother's  crystal  radio.  We  didn't 
have  anything  else  in  the  way  of 
manufactured  entertainment.  There 
was  no  television;  radio  was  not  all 
that  affordable  or  available  in  the 
hills  yet.  There  were  no  movie 


by  Bill  Pierson,  Managing  Editor 


houses  unless  you  went  to  Charles- 
ton, which  I don't  believe  I did 
through  the  first  5 years  of  my  life.  I 
do  vividly  remember  going  with  my 
father  to  the  airport,  such  as  it  was, 
in  Charleston  to  see  one  of  the  first  (if 
not  the  first)  commercial  airliners  to 
come  to  Charleston.  Seeds  of 
disbelief.  I still  hadn't  accepted  the 
fact  that  all  this  around  me  was  a 
part  of  "my"  world.  Violence  was 
totally  a "grown-up"  thing  in  far-off 
places. 

Recently,  I saw  Pope  John  Paul 
as  he  visited  Denver,  Colorado.  Here 
was  the  Holy  Father  of  the  Catholic 
religion  actually  in  Denver,  an 
otherwise  insignificant  speck  on  the 
world  map,  walking  on  ground 
familiar  to  me,  waving  at  people, 
talking  to  people  that  I see  on  a near 
daily  basis.  For  most  of  my  life  the 
Pope  was  in  the  Vatican  and  totally 
untouchable.  Oh,  I heard  of  some 
people,  mostly  my  fellow  reporters 
and  columnists,  who  went  to  Rome 
and  actually  had  a brief  audience 
with  the  Pope.  That  was  highly 
unusual. 

Pope  John  Paul  arrived  in 
Denver  and,  barely  off  the  huge 
airliner,  started  talking  about  vio- 
lence on  Denver's  streets. 

I'm  actually  not  going  anywhere 
with  this  thought  other  than  to 
contrast  the  hugely  different  worlds: 
that  of  my  isolated  childhood  and 
that  of  a couple  of  weeks  ago.  It's 
like  now  our  worlds  don't  just  brush 
briefly;  they're  colliding  almost 
daily...  and  I'm  being  jostled.  It 
makes  me  wonder  (as  all  of  us  have 
from  time  to  time)  if  that  other  world 
of  mine  wasn't  actually  better. 

But  that's  not  the  way  life  works. 


330 


Colorado  Medicine  for  September,  1993 


U Dir. 


Advocating  excellence  in  the  profession  of  medicine 


HEALTH  SCIENCES  LIBRARY! 
UNIVERSITY  OF  MARYLAND 

BALTIMORE 

OCT  271393  S'f'Ar 

*4 

REC’O.  NOT  IN  CIRC. 

i / 

his  Issue: 


Change  ...  Our  Greatest  Challenge  - (Special  Section)  In  its  123rd  year,  CMS  prepares 


for  and  adapts  to  change  in  the  practice  of  medicine 

Highlights  of  the  Annual  Meeting Page  345 

"Incorporating  the  Health  Care  Jungle"  - Lonnie  Bristow,  M.D.,  Chairman  of  the  Board,  AMA  Page  358 

"Threatened  Balkanization  of  the  (Medical)  Profession"  - William  Carl  Bailey,  M.D.,  President,  CMS Page  339 

"Guidelines  for  Health  System  Reform  " - CMS  Position  Statement Page  362 

"Rates  Up;  Prices  Down...  and  much  more"  - Copic  announces  new  rates Page  369 


Doctor,  Doctor! 
Come  Quick! 
There’s  a Process  Server 


in  the  Waiting  Room!’ 


An  unlikely  scenario?  Unfortunately,  no.  Colorado 
physicians  are  on  the  receiving  end  of  malpractice 
suits  on  the  average  of  once  every  seven  years. 

$ The  right  response?  Accept  the  summons 
or  subpoena,  then  pick  up  your  phone  and 
call  Copic  Insurance  Company  Headquarters, 
which  is  right  here  in  Colorado.  The  damage 
control  will  start  immediately,  and  you’ll 
feel  better  in  the  morning.  ♦♦♦  But,  you  say, 
what  if  the  targeted  physician  is  one  of  the 
minority  in  Colorado  who  didn’t  choose  Copic? 

♦♦♦  Well,  maybe  he  or  she  won’t  feel  better  in  the  morning. 

The  Copic  Bottom  Line.  It’s  more  than  just  competitive  rates. 


Opic 


Copic  Insurance  Company 

PO.  Box  17540  • Denver.  CO  80217-0540  • (303)  779-0044  • 1-800-421-1834 


Colorado  Medicine 

October,  1993  Volume  90,  Number  10 


Cover  Story 


Change  is  in  the  wind.  Can 
the  medical  profession  make 
something  positive  out  of  that 
change?  See  page  339  and 
pages  345  and  following. 


Departments 


339  President's  Letter 
345Annual  Meeting 
362  Health  System  Reform 
368Health  Care  Definitions 
379Medical  News 
382Component  Societies 
383  New  Members 
384Classified  Advertising 
386  Ruminations 


On  This 

339  The  Colorado  Medical  Society  and  the  Threatened 
Balkanization  of  the  Profession 

Wm.  Carl  Bailey , MD 
President,  Colorado  Medical  Society 

345  Special  Section — Annual  Meeting 

369  1994  Copic  Rates  Announced 

372  CMS  and  AMA  Education  and  Research  Foundations 

W.  Gerald  Rainer,  MD,  Chairman 
CMS-ERF 

374  Medical  Student  Component 

377  OSHA  Training  Requirements 

378  New  law  affects  deductibility  of  dues 


Colorado  Medical  Society 


COLORADO  MEDICAL  SOCIETY 
OFFICERS,  BOARD  MEMBERS  and  AMA  DELEGATES 


1993/1994  Officers 
Wm.  Carl  Bailey,  M.D. 

President 

David  C.  Martz,  M.D. 

President-elect 
Terrance  J.  Sullivan,  M.D. 

Treasurer 

Stuart  O.  Silverberg,  M.D. 

Speaker  of  the  House 

Ted  T.  Lewis,  M.D. 

Vice-speaker  of  the  House 

Sandra  L.  Maloney 

Secretary/Executive  Director 

Leigh  Truitt,  M.D. 

(Immediate  Past  President) 


Board  of  Directors 

Board  of  Directors 

Thomas  J.  Allen,  MD 

Joseph  R.  Tyburczy,  Jr.,  MD 

Stephen  G.  Batuello,  MD 

Denis  J.  Winder,  MD 

John  O.  Cletcher,  Jr.,  MD 

M.  Robert  Yakely,  MD 

Donald  G.  Eckhoff,  MD 

John  E.  Elliff,  MD 

AMA  Delegates 

Jonathan  C.  Feeney,  MD 

Joel  M.  Karlin,  MD 

M.  Ray  Painter,  Jr.,  MD 

David  M.  Knize,  MD 

Richert  E.  Quinn,  Jr.,  MD 

Robert  L.  Kruse,  MD 

Mark  A.  Levine,  MD 

Muryl  L.  Laman,  MD 

Louise  L.  McDonald,  MD 

Alternate  Delegates 

John  B.  Muth,  MD 

Robert  A.  Nathan,  MD 

Robert  D.  McCartney,  MD 

Lothar  K.  Roller,  MD 

Robert  M.  Bogin,  MD 

Elaine  N.  Scholes,  MD 

Joel  M.  Karlin,  MD 

Theresa  A.  Schoiz 

W.  George  Shanks,  MD 

Robert  R.  Montgomery, 

Susan  A.  Sherman,  MD 

Legal  Counsel 

COLORADO  MEDICAL  SOCIETY  STAFF 


Executive  Office 

Sandra  L.  Maloney,  Executive  Director 
Mary  Lee  Johnston,  Executive  Admin.  Asst. 
Nancy  L.  Deter,  Manager,  Accounting 

Western  Slope  Office 

Dolores  M.  Bennett,  Executive  Secretary 

Division  of  Membership  Information  Services 

Timothy  H.  Roberts,  Director 
Diane  L.  LeHew,  Manager,  Support  Services 
Debra  M.  Jones,  Membership  Coordinator 
Beth  M.  Crusha,  Administrative  Assistant 


Division  of  Health  Care  Policy 

Ellen  J.  Stein,  Director 

Marilyn  P.  Barton,  Program  Manager 

Lynn  R.  Livingston,  Administrative  Assistant 

Division  of  Health  Care  Financing 

Edie  K.  Register,  Director 
Marijo  M.  Parkin,  Program  Manager 

Division  of  Government  Relations 

Sue  Ellen  Quam,  Director 

Lorraine  L.  Koehn,  Program  Manager/Lobbyist 

K.  Suzanne  Hamilton,  Administrative  Assistant 


Division  of  Professional  Services 

Sandra  M.  Finney,  Director 
Lorraine  K.  Heth,  Program  Manager 
Kirsten  E.  Regalado,  Secretary 


Division  of  Communications 

William  S.  Pierson,  Director 

Michael  P.  Thompson,  Communications  Mgr. 

Gil  Maestas  II,  Communications  Specialist 


COLORADO  MEDICINE  (ISSN-01 99-7343)  is  published  monthly  as  the  official  journal  of  the  Colorado  Medical  Society,  7800  E.  Dorado  PI.,  Englewood,  CO  801 1 1 . Telephone  (303)  779-5455.  Outside 
Denver  area,  call  1 -800-654-5653.  Second  Class  postage  paid  at  Englewood,  Colorado,  and  at  additional  mailing  offices.  POSTMASTER,  send  address  changes  to  COLORADO  MEDICINE,  P.  O.  BOX 
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to  the  editorial  and  business  office.  Subscriptions  are  available  for  $30  per  year,  paid  in  advance. 

COLORADO  MEDICINE  magazine  is  the  official  journal  of  the  Colorado  Medical  Society,  but  as  such  is  also  authorized  to  carry  general  advertising.  Publication  of  any  advertisement  in  COLORADO 
MEDICINE  does  not  imply  an  endorsement  or  sponsorship  by  the  Colorado  Medical  Society  of  the  product  or  service  advertised.  Published  articles  represent  opinions  of  the  authors  and  do  not  necessarily 
reflect  the  official  policy  of  the  Colorado  Medical  Society  unless  clearly  specified. 

Sandra  L.  Maloney,  Executive  Editor;  William  S.  Pierson,  Managing  Editor;  Michael  Thompson,  Asst.  Managing  Editor,  Gil  Maestas,  II,  Communications  Specialist 


Member,  Colorado  Press  Association, 


Member,  Colorado  Broadcasters  Association 


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Patient  Education  Made  Easier 


For  many  years  now, 
computers  have  helped  physicians  and 
medical  practice  managers  perform 
complex  accounting  functions 
formerly  the  domain  of  manual 
clerical  systems.  Today,  producing 
insurance  claim  forms,  statements  and 
periodic  reports  are  routine  computer 
tasks  in  most  medical  practices. 

Because  accounts  receivable 
management  in  a medical  practice  is 
significantly  different  from  other 
small  businesses,  and  other 
accounting  functions  (accounts 
payable,  payroll,  etc.)  are  not,  it  is  no 
surprise  that  so  many  medical 
software  vendors  have  concentrated 
their  efforts  on  A/R.  In  fact,  there  are 
over  2,000  software  programs  geared 
toward  accounts  receivable  billing 
functions  for  medical  offices. 

But  as  computer  technology 
evolves,  so  do  the  applications  it  can 
be  applied  to.  Recent  advances  in 
high  resolution  graphics,  video  and 
touchscreen  technologies,  and  their 
associated  move  toward  affordability, 
have  produced  systems  that  promise 
to  revolutionize  the  way  health-care 
providers  are  trained,  and  in  turn  how 
they  deliver  information  to  their 
patients,  and  to  other  providers. 

The  Patient  Education  Series 
(P.E.S.)  from  Medical  Multi-Media, 
Inc.,  and  the  Animated  Dissection  of 
Anatomy  for  Medicine  (A.D.A.M. ) 
from  A.D.A.M.  Software,  Inc.  are  two 
examples  at  the  cutting  edge  of 
technologies  changing  the  way 
patients  and  physicians  communicate. 

The  P.E.S.  system  is  a multi- 
media-based package  designed  to  be 
operated  directly  by  the  patient  using 
a surprisingly  simple  touchscreen.  It 
combines  personal  computer,  video 
laser  disc  and  CD  technologies  to 


create  a non-threatening,  even 
entertaining,  encounter. 

After  arriving  at  a diagnosis 
and/or  course  of  treatment,  a physi- 
cian, using  a familiar  superbill-like 
form,  simply  checks  off  those 
modules  relating  to  the  patient's 
condition  or  treatment  he  wishes  seen. 
An  office  assistant  then  takes  the 
patient  into  a room  where  the  phys- 
ician's instructions  are  entered  into  the 
P.E.S.  system,  and  the  patient  is  given 
some  extremely  simple  operating 
instructions.  What  makes  th  P.E.S. 
system  so  successful  is  that  the 
patient's  involvement  is  limited  to 
touching  highlighted  boxes  on  the 
screen.  There  is  no  need  to  operate 
either  a keyboard  or  a mouse. 

The  P.E.S.  system  takes  the 
patient  on  an  interesting,  animated 
guided  tour  of  the  modules  that 
pertain  to  his  condition,  and  tracks 
everything  viewed.  It  quizzes  the 
patient  along  the  way  in  order  to 
ascertain  what  is  being  learned,  or 
what  needs  clarification.  This  step- 
by-step  record  will  later  become  the 
basis  for  a complete  informed  consent 
record,  produced  on  demand  at  the 
end  of  the  session. 

The  patient  may  even  stop 
the  session,  call  for  help,  and  record 
voice  questions  for  the  physician  to 
review  later;  all  by  simply  touching 
the  appropriate  box  on  the  screen. 

While  the  patient  is 
interacting  with  the  P.E.S.  system,  the 
physician  resumes  his  or  her  work 
with  other  patients,  maximizing 
professional  time  and  providing  the 
patient  with  complete,  detailed 
information. 

The  A.D.A.M.  system,  which 
runs  on  an  Apple  Macintosh  computer 
or  under  the  DOS/Windows  environ- 


ment, is  a powerful  anatomical 
illustration  tool  that  enables  health- 
care providers  to  view  the  human  body 
layer  by  layer,  and  highlight  or  draw 
anomalies  or  proposed  procedures, 
store  the  modified  graphic  image  and 
produce  printouts  and/or  transparen- 
cies. 

Using  a mouse-driven 
scalpel,  the  user  can  even  "practice" 
surgical  procedures  to  a surprisingly 
accurate  degree,  even  to  the  point  of 
first  staining  the  surgical  site  with 
Betadine. 

By  employing  A.D.A.M.,  a 
physician  can  produce  material  for 
patient  education,  communicate  highly 
accurate  and  very  detailed  anatomical 
information  to  colleagues;  anything 
which  might  otherwise  require 
cumbersome  artwork  pasting  or  hand 
drawing.  He  may  even  produce  step- 
by-step  "animated”  presentations,  such 
as  that  of  a C-section,  and  play  them 
back  for  patients  whenever  needed. 

Because  patients  educated 
with  these  systems  have  a better 
understanding  of  their  condition  and 
course  of  treatment,  they  are  easier  to 
treat  and,  ostensibly,  will  experience  a 
smoother  recovery.  In  addition,  both 
systems  go  a long  way  to  insulate  the 
physician  from  lawsuits  based  on 
patients'  claims  they  were  not  kept 
properly  informed. 

These  systems,  and  others 
like  them,  are  paving  the  way  for  a 
revolution  in  patient  - and  physician  - 
education  that  is  changing  our 
perceptions  much  as  they  were 
changed  by  the  billing  systems  we  are 
now  so  familiar  with. 

For  more  information:P.E.S.,  call  Barry  Roudi 
at  Medical  Multi-Media.  Inc.  (818)449-1705; 
AJDA.M.,  call  Paul  Carter  at  Healthcare 
Resources  of  Colorado  ( 303 )696- 7552. 


Wm.  Carl  Bailey,  MD 
President,  1993-1994 


President's 


Letter 


The  Colorado  Medical  Society  and  the 
Threatened  Balkanization  of  the  Profession 


Inaugural  address  (unabridged)  of  CMS  President,  Dr.  Wm.  Carl  Bailey 


Medical  practice  in  Colorado 
has  changed  incredibly  in  the  1 22 
years  since  our  organization  was 
founded.  Our  medical  society  has  a 
long  and  hard-earned  history  of 
survival  and  of  service  to  the  state  as 
it  has  sought  to  cope  with  change 
over  the  years. 

Theearly  Colorado  physicians,  not 
unlike  ourselves,  were  surrounded  and 
beset  by  all  kinds  of  quacks  and  heal- 
ers. We  ourselves  are  dealing  with 
"alternative"  medicine.  Educational 
standards  varied  enormously  among 
physicians  of  those  earlier  years,  from 
those  who  were  products  of  a univer- 
sity to  those  who  may  have  "read" 
medicine,  or  apprenticed  with  a physi- 
cian for  a year  or  so.  Our  profession 
has  since  made  vast  strides  in  educa- 
tion and  establishing  standards.  The 
democratic  impulse  among  the  popu- 
lace to  mistrust  science  and  the  learned 
professions  was  characteristic  of  the 
society  of  the  time,  and  vestiges  of  that 
tendency  continue  to  haunt  us  here  in 
Colorado.  The  lives  of  frontier  physi- 
cians were  often  hard  and  profession- 
ally isolated,  causing  them  to  join  to- 
gether for  mutual  support  in,  first,  the 
Denver,  and  then  a few  months  later  in 
the  Colorado  Medical  Societies.  The 
early  physicians  were  generally  poorly 
compensated,  and  with  notable  ex- 
ceptions frequently  had  to  sustain  them- 
selves with  other  various  commercial 
endeavors  or  occupations. 

The  Colorado  Medical  Society  was 
a powerful  influence  in  those  days  in 
stabilizing  the  practice  of  medicine, 
and  for  promoting  professionalism  and 
col legial ity . This  served  the  legitimate 
interests  of  medicine,  enabled  physi- 
cians to  develop  the  professional  and 
personal  life-stylewhich  made  the  prac- 
ticeof  medicine  rewarding,  and  served 


the  community  well. 

In  1904,  the  AMA  established  a 
council  on  medical  education  which, 
in  1910,  invited  the  Carnegie  Founda- 
tion for  the  Advancement  of  Teaching 
to  conduct  an  investigation  of  medical 
education.  To  do  this,  they  employed 
young  Abraham  Flexner,  an  education 
specialist  from  Johns  FHopkins.  The 
landmark  report  which  followed  re- 
sulted in  vastly  improved  standards  of 
education  of  physicians  and  dealt  seri- 
ously with  the  issues  of  funding.  An 
important  result  of  this  was  the  closure 
of  many  substandard  medical  schools, 
including  2 of  the  3 schools  then  in 
Colorado.  Out  of  this  report  also  grew 
the  idea  of  full-time  academics  who 
would  be  salaried  to  teach  and  do 
research,  without  the  necessity  of  sup- 
porting themselves  by  private  practice. 
(It  is  ironic  that  clinical  faculty  are 
again  becoming  more  dependent  on 
clinical  activity  to  support  medical 
school  subsidies.) 

The  arrival  of  the  Flexner  report 
heralded  the  modern  era  of  medicine 
and  the  beginning  of  what  Eli  Ginzberg 
has  identified  as  the  period  of  stability 
and  physician  dominance,  from  1910 
to  1965J  This  period  was  character- 
ized by: 

1.  Dominance  of  the  medical 
profession,  in  which  physicians 
were  clearly  the  leaders  of  health 
care.  Practice  was  predominantly 
conducted  solo  or  in  a small 
group. 

2.  Focal  sponsorship  and  control  of 
non-profit  hospitals  by  hospital 
boards.  There  was  a heavy 
reliance  on  philanthropy.  New 
services  were  established  on  the 
basis  of  perceived  community 
need,  rather  than  entrepreneurial 
profitability. 


This  is  a time  of  change. 

The  newspapers , radio , 
television , trade  journals , 
politicians , and  leaders 
everywhere  tell  us  this 
constantly.  A national 
political  campaign  was 
fought  over  a time  of 
change. 

It  is , therefore , appropriate 
that  change  should  be- 
come the  theme  of  this, 
the  1 23rd  Annual  Meeting 
of  the  Colorado  Medical 
Society. 


C' n In  m r! n Azf / r / rt  & 


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"The  shift  of  power  away  from  physician  dominance  now  occurred  and  proved  to  be 
one  of  the  most  destabilizing  influences  in  the  modern  history  of  medicine." 


3.  Cross-subsidization  of  care. 

Physicians  and  hospitals  took  care 
of  large  numbers  of  the  poor  and 
were  able  to  support  themselves 
by  charging  the  affluent  higher 
rates.  (I  think  that  it  is  important 
to  note  that  the  loss  of  this 
"informal"  system  of  "taxation" 
and  our  societal  failure  to  replace 
it  with  an  acceptable  substitute  is 
a major  cause  of  the  health  care 
crisis  that  afflicts  us  today.) 

As  part  of  this,  the  Blues  Plans  were 
developed  by  physicians  using  com- 
munity rating  with  affordable  premi- 
ums based  on  income,  so  that  most, 


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including  the  poor  and  near  poor,  even 
if  poor  risks,  were  provided  insurance. 
Physicians  who  belonged  to  the  plan 
accepted  lower  than  usual  and  cus- 
tomary fees  in  order  to  support  the 
system. 

Subsequent  to  this  six-decade  pe- 
riod of  relative  stability  there  began  in 
1 965  the  process  of  destabilization  to 
which  we  attribute  many  of  the  prob- 
lems we  are  currently  experiencing. 

In  the  1960s  the  federal  govern- 
ment had  taken  active  measures  to 
increase  the  number  of  physicians,  on 
the  theory  that  this  would  result  in 
lowered  health  care  costs.  By  the  1 970s 
the  supply  of  physicians  had  doubled, 
resulting  in  a significant  over-supply 
and  contributing  to  this  destabiliza- 
tion. Another  factor  was  the  arrival  of 
broad  health  insurance,  including  first 
dollar  coverage  which  fostered  over- 
utilization. This  destabilization  was 
further  accelerated  by  the  establish- 
ment of  Medicare  and  Medicaid.  This 
increased  third  party  payments  for  hos- 
pitals from  77%  to  91%  of  total  costs, 
thus  contributing  to  a strong  and  rela- 
tively risk-free  cash  flow.  For  the  non- 
profit hospitals  this  provided  a new 
opportunity  for  capitalization  and  ex- 
pansion in  the  form  of  tax-free  bonds. 
The  new  development  also  presented 
a nearly  irresistibleopportunity  for  Wall 
Street  investors  and  the  advent  of  large 
for-profit  hospitals  and  health  care 
groups.  This  contributed  to  a profusion 
of  entrepreneurial  ventures  based  on 
the  "bottom  line",  which  were  then 
mirrored  on  the  non-profit  side.  The 
large  influx  of  capital  and  a more  busi- 
ness oriented  health  industry  produced 
the  rise  of  the  lay  manager  with  squads 
of  attorneys,  accountants,  and  middle 
managers  as  a serious  force  about  this 
time. 

Concurrently,  an  unintended  con- 


sequence was  barely  noticed.  Th  is  was 
the  erosion  of  power,  influence  and 
interest  on  the  part  of  many  boards  of 
trustees  of  local  hospitals.  With  this 
was  lost  the  counterbalance  of  com- 
munity leaders  on  the  flywheel  of  un- 
encumbered expansionist  hospital  ad- 
ministration, now  no  longer  so  depen- 
dent on  philanthropy. 

The  combination  of  corporate  self 
insurance,  the  tightening  of  payment 
practices  of  insurance  companies,  and 
the  growth  of  volume  discounting  by 
preferred  provider  organizations  now 
converged  to  slash  the  revenues  which, 
in  former  times,  were  used  by  doctors 
and  hospitals  to  cross-subsidize  indi- 
gent care. 

The  shift  of  power  away  from  phy- 
sician dominance  now  occurred  and 
proved  to  be  one  of  the  most  destabi- 
lizing  influences  in  the  modern  history 
of  medicine.  Ginzberg  identifies  ten 
principal  centersof  powerwhich  influ- 
ence health  care  delivery: 

• The  federal  government,  which 
funds  over  42%  of  all  health  care 
and  85%  of  research; 

• State  government,  with  its  Medic- 
aid burden; 

• the  business  community,  with  self 
insurance  and  purchasing  coali- 
tions; 

• the  hospital  systems  turning  to 
vertical  integration  and  competing 
aggressively  with  their  own  staffs 
and  other  physicians; 

• insurance  companies,  which  have 
tended  to  make  profits  by  insuring 
only  the  healthy,  and  which  are 
now  involved  in  direct  health  care 
delivery; 

• the  legal  industry  with  costs  of 
litigation  and  the  far  greater  hidden 
costs  of  defensive  medicine; 

• organized  consumer  groups  such 
as  the  AARP  with  its  entitlements 


340 


Colorado  Medicine  for  October,  1 993 


" ...the  good  news  is  that  the  essential  necessity  for  physicians  to  lead  in  the  de- 
velopment of  cost-effective,  outcome  driven  healthcare  is  recognized." 


for  the  wealthy; 

• the  large  for-profit  hospital  and 
medical  organizations  which  seem 
to  be  proliferating; 

• the  Guadalajara  Syndrome,  in 
which  no  control  can  be  asserted 
over  the  training  of  new  physicians 
in  off-shore  medical  schools;  the 
national  political  arena  and  to  all 
of  these  we  would  add  to  an 
eleventh  power  center  in  the  form 
of  all  the  various  non-physician 
providers,  such  as  nurse  practitio- 
ners, physician  assistants,  thera- 
pists, etc. 

Each  of  these  entities  has  itsown  agenda 
and  perceived  self  interest.  Physicians 
are  no  longer  the  sole  arbiters. 

Since  roughly  1 985,  we  have  been 
in  the  current  and  thus  far  indetermi- 
nate era  of  Corporatization.  Fee-for- 
service  medicine  appears  on  the  way 
out  and  rapidly  being  replaced  by  vari- 
ous forms  of  managed  health  care. 
Deep  discounting,  bulk  purchasing, 
micro-management  and  economic 
credentialling  appear  the  order  of  the 
day.  Solo  or  small  group  practice,  ex- 
cept among  rural  providers  and  some 
specialist,  appears  headed  for  extinc- 
tion. Doctors  are  joininggroups,  merg- 
ing, imploring  hospitals  to  buy  out 
their  practices,  and  desperately  seek- 
ing some  kind  of  economic  security. 
A whole  new  corporate  industry  has 
sprung  up,  with  names  like  Health 
Maintenance  Organization,  Indepen- 
dent Practice  Association,  Preferred 
Provider  Organization,  Exclusive  Pro- 
vider Organization  and  others.  Seek- 
ing to  eliminate  "the  middle  man", 
organizations  are  integrating,  either 
vertically  or  horizontally.  Indemnity  is 
outand  capitation  is  in.  Meanwhilethe 
competition  to  manage  the  integrated 
organization  is  hot  and  heavy.  In  some 
cases  insurance  companies  or  other 


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" ...  physicians  are  being  cut  off  from  sometimes  large  segments  of  the 
independent ; private  practices  which  they  may  have  painstakingly  built 
over  years." 


financial  organizations  have  taken  over 
integrated  networks  and  are  directly 
managing  both  hospitals  and  physi- 
cians. In  other  cases  hospital  adminis- 
trators have  moved  to  employ  physi- 
cians directly  and  to  seek  contracts 
with  business  or  insurance  companies. 
Physician  owned  and  managed  net- 
works make  up  another  category.  We 
are  now  seeing  the  third  generation  of 
integrated  systems,  namely  the  Ac- 
countable Health  Plan  (AHP)  or  part- 
nership. On  the  purchaser  side,  the 
buzz  word  is  HIPC  or  Health  Insurance 
Purchasing  Coalition.  Under  the  soon- 
to-be-revealed  Clinton  proposal  it  is 
anticipated  that  a few  large  employer 
groups  in  HIPCs  will  purchase  inte- 
grated health  care  from  a few  large 
providers.  This  is  called  managed  care 
competition,  and  is  designed  to  con- 
trol costs,  even  though  it  has  been 
demonstrated  that  competition  may  in 
fact  be  the  opponent  of  cost  control. 

Meanwhile,  the  stakes  are  high 
and  competition  to  see  who  will  con- 
trol these  organizations  is  intense.  All 
across  the  country  managed  care 
groups  are  being  merged,  bought  and 
sold,  and  much  to  the  consternation  of 
some  physician  members  who  find 
themselves  being  deeply  discounted, 
some  of  the  insiders  on  occasion 
emerge  with  millions  of  dollars  in  cash 
or  stock  options. 

There  is  a great  deal  of  money  to 
be  made  in  health  care,  even  though 
some  physicians'  personal  experience 
wou  Id  suggest  that  they  themselves  are 
unlikely  to  share  much  of  it.  The  final 
result  is  the  coalescence  of  multiple 
small  companies  into  a few  large  ones. 
Some  doctors  are  signing  bad  con- 
tracts out  of  ignorance,  fear,  or  greed, 
as  they  seek  to  compete  not  for  indi- 
vidual patients,  but  for  corporately- 


owned  blocks  of  patients. 

Only  in  a relatively  few  places  are 
physicians  exerting  leadership  in  own- 
ing or  managing  integrated  groups.  It  is 
significant  that  some  experts  on  the 
third  generation  of  integrated  systems 
(AHPs)  are  emphasizing  a new-found 
importance  for  physicians.  Jeff  Gold- 
smith, Ph.D.,  a health  care  consultant 
for  Ernst  and  Young  asserts  that  the 
cooperation  and  indeed  the  manage- 
ment skills  of  physicians  in  networks  is 
essential  to  their  success. 2 He  suggests 
that  only  by  "ceding  real  power  to  a 
group  of  physicians  can  true  integra- 
tion be  achieved".  Goldsmith  also 
draws  attention  to  several  obstacles  to 
these  relationships  which  have  to  do 
with  the  prevailing  culture  of  physi- 
cians. He  points  to  the  only  true  ex- 
amples of  real  integration  of  health 
care  which  are  the  Mayo  clinic  and 
Kaiser.  Both  are  completely  integrated, 
and  both  are  unabashedly  (and  suc- 
cessfully) doctor-run  organizations. 
Both  have  required  three  generations 
to  achieve  their  present  status,  and 
both  are  characterized  by  a unique 
degree  of  col  legial  ity . He  emphasizes 
that  in  these  examples,  the  fundamen- 
tal organizing  principle  is  not  sharing 
of  power,  but  the  emergence  of  col  le- 
gality, tolerance,  and  sharing  of  com- 
mon professional  values.  The  trust  and 
sharing  of  values  is  the  central  precon- 
dition of  the  ability  to  share  and  suc- 
cessfully manage  the  economic  risk  of 
health  costs,  according  to  this  author. 
He  states: 

"Col  legial  ity  within  an  organized  prac- 
tice may  be  the  only  shelter  physicians 
have  from  the  corrosive  suspicion  and 
case-by-case  second  guessing  of  clini- 
cal decisions  that  have  overwhelmed 
private  practice.  Collegial  norms  of 
conservative  medical  practice  render 


hour  by  hour  practice  controls  unnec- 
essary. Formalizing  these  norms,  cre- 
ating clinical  protocols  to  make  them 
explicit,  and  explicitly  linking  them  to 
clinical  outcomes,  is  the  ultimate  goal 
of  the  outcomes  movement  in  contem- 
porary medicine." 

Goldsmith,  however,  also  points 
out  the  long  history  of  mutual  distrust 
between  administrators  and  doctors, 
which  will  not  be  easily  dispelled.  The 
key  issue  which  he  identifies  is  the 
culture  of  fee-for-service  physicians. 
"Most  physicians  crave  order  but  de- 
spise authority".  Long  deprived  of  au- 
thority in  their  own  institutions,  they 
resort  to  guile  and  guerrilla  warfare  to 
win  their  battles.  They  are  incapable  of 
submitting  to  the  authority  of  others, 
physician  or  non-physician.  "They  are 
in  short,  terrible  employees.  Ask  any 
dean  or  group  practice  CEO".  Gold- 
smith concludes  that  the  current  gen- 
eration of  healthcare  executives  and 
physician  leaders  are  caught  in  a tran- 
sition from  atomized  entrepreneurship 
to  an  organized,  collegial  culture,  and 
have  few  of  the  skills  needed  to  func- 
tion in  an  organized  system.  Thus,  the 
good  news  is  that  the  essential  neces- 
sity for  physicians  to  lead  in  the  devel- 
opment of  cost-effective,  outcome 
driven  healthcare  is  recognized.  We 
are,  in  fact,  seeing  the  emergence  of  a 
corps  of  capable  physician  managers. 
The  bad  news  is  that  it  is  going  to  take 
a physician  cultural  revolution  for  most 
of  us  to  be  comfortable  and  effective  in 
the  new  order  of  things. 

There  are  many,  many  other 
changes  occurring  with  which  we  must 
deal.  On  one  hand,  there  is  a huge 
emphasis  on  primary  care.  On  the  other 
hand,  there  are  too  many  specialists 
and  they  are  being  summarily  shed  by 
some  organizations.  By  a stroke  of  the 


pen  by  strangers,  with  no  discernible 
cause,  physicians  are  being  cut  off 
from  sometimes  large  segments  of  the 
independent,  private  practices  which 
they  may  have  painstakingly  builtover 
years.  This  raises  the  specter,  in  the 
minds  of  some,  of  physicians  unem- 
ployed or  seriously  underemployed,  a 
circumstance  not  seen  since  the  great 
depression  when  some  worked  as  taxi 
drivers  and  postal  clerks. 

Time  does  not  permit  exploration 
of  some  other  critical  areas  in  the  new 
corporate  culture,  medical  ethics  and 
the  development  of  health  policy,  for 
example.  What  about  rationing,  allo- 
cation of  scarce  resources,  prolonging 
death,  genetic  engineering  and  assisted 
suicide?  Howare  we  goingtodeal  with 
the  insertion  of  the  mercantile  ethic 
implicit  in  the  managed  care  equation 
and  how  does  that  conflict  with  medi- 
cal ethics?  How  do  we  preserve  the 
doctor-patient  relationship  in  a corpo- 
rate environment,  and  does  it  matter? 
Whose  job  is  it  to  advocate  for  society 
at  the  bedside?  Whose  to  advocate  for 
the  patient? 

All  these  are  serious  ethical  issues 
which  physicians  mustface themselves 
with  patients,  or  assist  society  to  an- 
swer for  us.  We  also  face  some  pro- 
foundly perplexing  questions  in  the 
area  of  our  educational  system,  spe- 
cifically in  medicine.  What  will  the 
effect  of  health  financial  reform  have 
on  our  medical  schools?  How  will 
medical  education  be  funded?  How 
much  debt  can  we  expect  a medical 
student  to  carry,  particularly  when  one 
must  now  look  forward  to  reduced 
physician  incomes.  Who  will  deter- 
mine what  medical  specialty  training 
will  be  provided,  and  how  it  will  be 
funded?  If  medical  schools  must  fund 
themselves,  in  what  activities  should 


they  engage,  and  what  should  be  their 
place  in  themarket?  Istheregoingto be 
money  available  for  research? 

Over  the  past  few  years,  we,  as 
physicians  have  experienced  a sea 
change  in  our  entire  culture,  value 
system,  professional  standards,  and  life- 
style. We  are  still  valued  by  the  major- 
ity of  our  fellow  citizens  as  a learned 
profession  which  can  regulate  itself. 
But,  partly  due  to  an  environment  over 
which  we  have  no  control,  and  partly 
because  of  weaknesses  in  ourselves, 
we  have  lost  the  moral  right  to  health- 
care leadership  which  once  was  ours. 
For  the  good  of  the  people,  we  must 
regain  that  position. 

It  is  beginning  to  look  like  the 
States  are  going  to  assume  the  respon- 
sibility in  large  measure  for  health  care 
reform.  The  responsibility,  and  the 
opportunity  for  the  Colorado  Medical 
Society  to  be  an  effective  force  for 
leadership  in  this  critical  area  has  never 
been  greater.  At  stake  is  far  more  than 
the  economic  well-being  of  a few  phy- 
sicians and  other  health  providers.  The 
time  has  come  for  us  to  take  the  high 
ground  and  preserve  and  hopefully 
improve  the  health  and  the  social  fab- 
ric of  the  society  in  which  we  live.  If, 
now,  we  fail  to  act  in  concert  and  with 


determination,  the  loss  may  be  incal- 
culable. 

Colorado's  physicians  must  speak 
with  one  voice.  We  must  educate  our- 
selves and  the  public.  It  is  a time  for  the 
CMS  to  become  more  efficient,  more 
informed,  and  moreskilled.  Itistimeto 
reach  out  in  coalitions  and  partner- 
ships. The  average  physician  today  is 
working  59  hours  per  week;  his  in- 
come is  going  down  as  his  overhead 
and  the  hassle  factor  goes  up.  Yet  the 
need  for  loyalty,  commitment,  and 
support  for  CMS  has  never  been  as 
great.  We  need  the  best  leaders  we  can 
find,  and  we  must  support  them.  Pri- 
vate practice  as  most  of  us  have  known 
it,  is  headed  for  the  tar  pits.  We  can  no 
longer  be  an  organization  of  just  pri- 
vate practitioners.  We  must  reach  out 
to  all  physicians  and  other  legitimate 
partners  in  health  care  in  new  coali- 
tions. If  we  do  not,  we  are  irrelevant, 
and  the  world  will  be  poorer  for  it.  We 
must  be  players,  and  not  pawns  in 
someone  else's  game.  Thank  you  again 
for  your  support,  and  for  hearing  me 
out.  I hope  we  have  a great  year  to- 
gether! 

References: 

1 . Ginzberg,  Eli,  The  Medical  Triangle:  Physicians,  Politics  and 

the  People,  Harvard  University  Press,  Cambridge,  Mass.  '93. 

2.  Goldsmith,  Jeff  C.,  Driving  the  Nitroglycerine  Truck:  Health 

Care  Forum  Journal,  March/April,  '93. 


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Colorado  Medicine  tor  October  1993 


343 


Presentation  of  the 
1 993  A.  H.  Robins 
Physician  Award 

Community  Service 
to 

James  R.  Dunn,  M.D. 
September  1 0,  1 993. 

The  award  was  presented 
at  the  1 23rd  Annual  Meeting 
of  the  Colorado  Medical  Society. 


Following  are  the  remarks  of  Leigh  Truitt , M.D.,  1992-1993  President  of  the  Coloardo  Medical  Society,  in 
presenting  the  award. 

"Each  year  the  Colorado  Medical  Society  has  the  privilege  and  pleasure  of  presenting  an 
award  to  a physician  for  outstanding  community  service.  This  award  recognizes  a physician 
for  services  outside  the  usual  medical  services  which  we  deliver  to  our  patients. 

This  year's  honoree  is  a person  who  has  practiced  medicine  on  the  Western  Slope  of 
Colorado  for  over  30  years.  During  all  that  time  he  has  been  a staunch  supporter  of  his 
community  and  a willing  contributor  to  many  public  service  projects.  He  has  been  an  active 
member  of  his  Lion's  Club  and  his  church,  but  beyond  that  he  has  been  a teacher,  a mentor, 
an  outstanding  role  model  for  his  community's  youth. 

In  addition  to  all  this,  our  awardee  has  taken  two  days  each  month  out  of  his  life,  and  flown 
his  own  aircraft  to  Central  New  Mexico  to  provide  clinical  services  as  well  as  a great  deal  of 
counseling  to  a Navajo  indian  tribe  in  a remote  area  of  the  state.  He's  been  doing  this  mission 
work  for  28  years. 

Our  honoree  and  his  wife  have  also  been  involved  in  a worldwide  organization  which 
contributes  time,  energy  and  supplies  to  build  schools,  chuches  and  community  meeting  halls. 
While  our  honoree  has  served  in  these  worldwide  projects  as  a "finish  carpenter,"  his  wife  has 
helped  as  a cook. 

We  can  say  agreat  deal  more  about  this,  and  I urge  you  all  totalkto  him  personally  to  hear 
about  these  experiences,  but  the  Wyeth-Ayerst  Laboratories  says  it  all  in  the  A.  H.  Robins 
Physician  Award  for  Community  Service,  presented  at  this  time  to  Dr.  James  Dunn  of  Grand 
Junction,  Colorado." 


James  R.  Dunn,  M.D. 


Special  section  on  the 

123rd  Annual  Meeting 

of  the 

CMS  House  of  Delegates,  September  1 0-1 2, 1 993 


Change • • • 1 994  and  years  beyond  will  see  much  change,  and  physicians  can  be  ready 
for  it  or  cairrefuse  to  adapt.  Whatever  their  attitude,  dramatic  change  in  the  practice  of  medicine 
will  occur.  Wm.  Carl  Bailey,  MD,  installed  as  the  1 993-1 994  President  of  the  Colorado  Medical 
Society,  stressed  that  CMS  does  rightfully  stand  for  change  and  for  progress.  As  his  theme  for  the 
1 993  Annual  Meeting  of  the  House  of  Delegates,  Dr.  Bailey  and  others  addressed  the  change 
which  medicine  is  now  undergoing.  His  inaugural  address  and  the  remarks  of  others  delivered  to 
this  123rd  meeting  are  reprinted  herein. 


Invocation  delivered  by  Dr.  Wyley  Eaton,  of  Golden,  on  the  opening  of  the  House  of  Delegates 
September  10,  1993,  Snowmass  Conference  Center,  Snowmass  Village,  Colorado. 

I invite  each  of  you  to  open  your  hearts  and  minds  to  your  Creator  as  you  deliberate  the  difficult 
decisions  that  must  be  made  during  this  session  of  the  House  of  Delegates.  Change  is  the  only 
constant  in  life;  it  is  never  easy  - it  is  always  a risk! 

These  are  the  toughest  of  times;  wanting  to  do  right  without  losing  safety,  not  knowing  if  we  are 
doing  God's  work,  or  using  God  to  do  ours. 

There  is  no  superhighway  named  Right  Way.  There  are  no  signposts,  no  guides,  no  promises,  no 
guarantees;  only  the  lonely  voice  of  conscience  and  the  cringing  cry  of  fear  wrestling  each  other 
in  our  inner  space. 

These  are  the  times  of  lying  awake  at  night  and  staring  at  the  detail  of  the  day  through  a haze  of 
worry;  working  and  reworking  the  "oughts"  and  the  "shoulds"  and  the  "yes,  buts..."  of  our 
decisions. 

And  so,  what  is  to  be  done  but  to  listen  to  the  voice  that  seems  to  be  speaking  a consistent  truth; 
move  through  the  fear  to  trust  the  moral  judgments  we  have  lived  by,  and  pray  tor  courage!  Amen. 

Excerpted  from  Elizabeth  Zarbox,  Unitarian-Universalist  minister. 


Colorado  Medicine  for  October,  1993 


345 


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346 


Colorado  Medicine  for  October,  1993 


t / 992-  1 993  CMS  President ; 
Leigh  Truitt MD  congratulates 
1993-1994  CMS  President 
Wm.  Carl  Bailey ; MD  as  he 
accepts  the  reins  of  the  medi- 
cal society  from  Dr.  Truitt. 


* Dr.  Bailey  chose  this  is  as 
the  theme  of  his  inauguration 
and  the  CMS  philosophy  for 
the  coming  year.  Many  attend- 
ees wore  buttons  bearing  this 
symbol.  CMS  is  in  the  Delta 
(signifying  change)  and  that 
change  is  carried  forth  as 
progress. 


Colorado  Medicine  for  October, 


Annual  M 


Dr.  Bailey  presented  Dr.  Truitt 
with  the  President's  Certificate 
of  Service  in  honor  of  his 
contribution  to  the  society  and 
organized  medicine  in  serving 
as  President  for  1992-1993. 

♦ 


Vermont  Governor  Howard 
Dean , MD , both  commiserated 
with  physicians  over  bureau- 
cratic rules  and  paperwork  and 
told  them  they  rely  too  much 
on  technology  and  less  on 
clinical  judgment  these  days. 


♦ 


1 993 


i Dr.  Bailey  enjoys  a moment 
with  Dr.  Lonnie  Bristow , 
chairman  of  the  AMA  Board  of 
Trustees  during  the  educa- 
tional program  Saturday  morn- 
ing. The  program  centered  on 
partnerships  that  physicians 
might  have  with  corporations 
and  with  allied  health  care 
providers.  Dr.  Bristow  spoke 
on  the  corporate  aspects  of 
medical  practice. 


i Dr.  james  R.  Dunn  of 
Grand  junction  accepts  the 
Robins  Award  for  outstanding 
community  service  by  a physi- 
cian, as  Sandra  L.  Maloney , 
CMS  Executive  Director  and 
Dr.  Truitt  look  on.  Dr.  Dunn 
was  accompanied  by  a signifi- 
cant contingent  of  friends  and 
family  members  who  con- 
gratulated him  on  this  achieve- 
ment. 


347 


Annual  Meeting 


'93 


Dr.  Leigh  Truitt  is  happy  to  be  able 
to  present  those  members  of  the  50 
year  club  who  are  attending  with 
their  pins.  This  award  honors  the 
fiftieth  anniversary  of  graduation 
from  medical  school. 


Anthony  Nagorka,  MD  is  a resident 
in  Arizona  now,  but  he  previously 
served  for  several  years  as  the 
President  of  the  Medical  Student 
Component  Society.  Current  students 
credit  Dr.  Nagorka  with  much  of  the 
work  which  has  increased  the 
membership  and  activities  of  the 
Medical  Student  Component  drama- 
tically. Tor  this  reason  he  was  given 
this  year's  Medical  Student  Leader- 
ship Award,  here  presented  by  CMS 
Executive  Director  Sandra  L.  Malon- 
ey. 


MCS  members  joined  for  breakfast 
before  the  educational  program 
started  Saturday.,  The  informal 
conversation  and  fellowship  made 
these  some  of  the  best  seats  in  the 
house. 


We  don't  usually  get  to  see  him  like  this... 

(Assistant  Editor's  Note:  Our  managing  editor,  Mr.  Pierson,  does  not  necessarily  endorse  this  tooting  of  his  horn.) 


CMS  Director  of  Communications  William  S.  Pierson  was  selected  by 
President  Leigh  Truitt,  MD  as  the  recipient  of  this  year's  Presidential  Staff 
Recognition  Award.  No  one  was  surprised  at  the  honor  except  Bill  himself 
who  was  rendered  speechless  (well,  almost)  as  he  accepted  the  plaque  from 
Dr.  Truitt  and  CMS  Executive  Director  Sandra  Maloney. 


348 


Colorado  Medicine  for  October,  1993 


Annual  Meeting 


Three-Way  Race  for  President-Elect 


For  the  first  time  in  several  years,  there  were  three  candidates  for  President-Elect  at  this  year's  Annual  Meeting.  Dr.  M. 
Ray  Painter,  Jr.  of  Glenwood  Springs  was  originally  chosen  by  the  nominating  committee,  but  later  pulled  out  of  the 
election.  He  suggested  that  his  friend  Dr.  Muryl  Laman  of  Pueblo  should  run.  Dr.  Laman  acceded  to  this  request.  In 
the  meantime,  Dr.  David  Martz  of  Colorado  Springs  had  been  drafted  into  the  race  by  some  of  his  friends  who  had 
heard  that  Dr.  Painter  was  no  longer  running.  The  latter  two  candidates  were  both  campaigning  hard  when  Dr. 
Painter's  friends  managed  to  convince  him  to  re-enter  the  race.  He  was  then  nominated  from  the  floor  in  the  House  of 
Delegates,  making  a three-way  race. 


It  took  two  ballots  to  elect  Dr. 
Martz  because  none  of  the  three  got 
a clear  majority  on  the  first  vote. 
Interestingly,  there  was  no  acrimony 
or  mudslinging  from  the  floor  after 
such  a close  vote.  Indeed  both  Dr. 
Painter  and  Dr.  Laman  congratulated 


M.  Ray  Painter,  Jr.,  MD 


"The  people  have  spoken  and 
the  election  is  over.  I pledge 
my  full  support  to  Dr.  Martz  as 
he  helps  lead  us  into  the 
uncertain  future  of  health  care. 
With  the  pressures  being 
brought  to  bear  on  physicians , 
we  need  to  stand  united  in 
promoting  the  best  interests  of 
our  patients ." 


David  C.  Martz,  MD 
1993-1994  CMS  President-Elect 


"Despite  the  fact  that  this  was 
a three  way  race  for  the  first 
time  in  many  years , it  did  not 
appear  to  result  in  any 
divisiveness  within  the 
organization.  It  is  our  hope 
that  unity  will  be  the 
trademark  of  Colorado 
physicians  in  the  crucial  years 
ahead. " 


Dr.  Martz  and  pledged  their  support 
to  his  presidency.  Dr.  Painter,  the 
other  candidate  in  the  second  vote, 
hugged  Dr.  Martz  after  the  results 
were  announced  and  said  he  would 
fully  support  his  administration. 


Muryl  L.  Laman,  MD 


"I  think  there's  absolutely  no 
doubt  that  we  need  to  pull 
together  for  the  good  of  the 
society.  It's  kind  of  like  a 
family,  you  may  have  some 
internal  differences,  but  when 
outside  influence  come  to 
bear,  we  all  join  together  for 
the  common  good. " 


Annual  Meeting  '93 


PROCEEDINGS  OF  THE  HOUSE  OF  DELEGATES 
ANNUAL  MEETING  1993 

The  Colorado  Medical  Society  House  of  Delegates  met  at  the  Snowmass  Conference  Center,  Snowmass  Village, 
Colorado  on  September  1 0 - 12,  1 993  and  took  the  following  actions: 

REFERENCE  COMMITTEE  ON  BOARD  OF  DIRECTORS/CONSTITUTION  & BYLAWS 

Adopted  a Resolution  amending  the  Bylaws  to  state  that  the  Chair  of  the  Nominating  Committee  shall  be  elected 
by  the  majority  of  the  members  of  the  Nominating  Committee  and  may  not  serve  two  consecutive  years.  Also, 
candidates  interested  in  elective  office,  must  make  their  declarations  no  later  than  June  30th. 

Adopted  a Resolution  which  allows  a Colorado  Medical  Society  Task  Force  study  the  feasibility  of  sponsoring  a 
statewide  Independent  Practice  Association  (IPA). 

Adopted  a Resolution  which  states  that  Colorado  Medical  Society  dues  no  longer  be  used  to  subsidize  the 
Accreditation  Program  but  to  seek  ways  to  make  the  program  self-supporting. 

Adopted  a Resolution  which  states  that  the  existing  Council  and  Committee  structure  (with  the  exception  of  the 
Council  on  Legislation)  be  modified  to  consist  of  an  overseeing  Council  on  Health  Affairs  and  the  formation  of  Task 
Forces  as  needs  arise. 

Adopted  a Resolution  to  amend  the  Bylaws  to  permit  an  Interim  Meeting  which  may  or  may  not  include  conven- 
ing the  House  of  Delegates. 

Adopted  a Resolution  to  make  certain  modifications  to  the  CMS  guidelines  for  Health  System  Reform. 

Accepted  for  filing: 

Progress  Report  - AMA  Delegation 

Progress  Report  - Board  of  Directors 

Progress  Report  - Council  on  Legislation 

Progress  Report  - Council  on  Legislation  - COMPAC 

Progress  Report  - Medical  Practice  Act  Task  Force 

Progress  Report  - Executive  Director 

Progress  Report  - CMS  Education  & Research  Foundation 

Progress  Report  - Health  System  Reform  Committee 

Progress  Report  - Organizational  Study  Committee 

Progress  Report  - Council  on  Professional  Education 

Progress  Report  - Physician  Health  Issues  Committee 

Progress  Report  - Women  in  Medicine  Section 

REFERENCE  COMMITTEE  ON  COMMUNITY  HEALTH  ISSUES/MEDICAL  SERVICE 

Adopted  a Resolution  which  states  that  the  Colorado  Medical  Society  supports  collaboration  of  advanced 
practice  nurses,  clinical  pharmacists,  physician  assistants  and  physicians  in  a manner  which  would  define  and  clarify 
educational  standards  and  expand  the  role  of  this  team  in  medically  underserved  areas  and  populations. 

Adopted  a Resolution  which  states  that  CMS  supports  the  concept  of  the  establishment  of  employer  based  day 
care  centers  for  employees  and  directs  the 

Women  in  Medicine  Section  to  obtain  existing  information  regarding  this  subject. 

Adopted  a Resolution  stating  CMS  play  an  active  role  in  the  design  and  implementation  of  an  integrated  state- 
wide trauma  system  which  is  consistent  with  recognized  national  standards  and  to  take  appropriate  legislative  action 
to  assure  the  passage  of  such  a trauma  system. 

Adopted  a Resolution  that  encourages  recognition  of  the  nursing  home  patient's  rights  to  being  transported  to  the 


350 


Colorado  MpHiririP  tnr  Ortnhpr  1993 


Annual  Meeting 


hospital  of  choice  whenever  possible. 

Adopted  a Resolution  regarding  the  privacy  of  an  individual's  genetic  information  and  states  CMS  will  work  in 
collaboration  with  the  Commission  on  Life  and  the  Law  to  seek  legislation  which  will  affirm  the  privacy  and  confi- 
dentiality of  genetic  information. 

Adopted  a Resolution  which  calls  for  CMS  to  participate  in  efforts  to  change  existing  laws  and  regulations 
regarding  legal  aspects  of  domestic  violence  and  to  determine  ways  and  means  to  provide  regional  training  opportu- 
nities to  physicians  regarding  domestic  violence. 

Adopted  a Resolution  which  acknowledges  that  societal  violence  is  a public  health  hazard  and  supports  ongoing 
legislative,  law  enforcement  and  educational  efforts  to  reduce  violence  in  our  society. 

Accepted  for  filing: 

Progress  Report  - Council  on  Community  Health  Issues 
Progress  Report  - Council  on  Medical  Service 


REFERENCE  COMMITTEE  ON  PHYSICIAN/PATIENT  ADVOCACY 

Adopted  a Resolution  which  seeks  implementation  of  a uniform  insurance  claim  form  and  a requirement  that  all 
insurance  companies  receive  electronic  claims. 

Adopted  a Resolution  which  states  that  the  Colorado  Medical  Society  seek  reimbursement  for  completion  of  all 
mandated  forms. 

Adopted  a Resolution  which  states  that  the  Colorado  Medical  Society  supports  the  concept  of  payment  reform  in 
which  fair  and  equitable  payments  are  made  across  specialty  lines  and  geographic  areas. 

Adopted  a Resolution  that  the  Colorado  Medical  Society,  through  the  AMA  and  local  efforts  ,seek  reimbursement 
for  appropriate  medical  services  delivered  over  the  telephone. 

Adopted  a Resolution  that  the  Colorado  Medical  Society  continue  to  support  the  concept  of  increasing  the 
Medicare  conversion  factor. 

Accepted  for  filing: 

Progress  Report  - Council  on  Physician/Patient  Advocacy  (PPAC) 


NOMINATING  COMMITTEE  REPORT 
Election  Results 

President-Elect  (one  year  term): 

David  C.  Martz,  M.D.,  El  Paso 
Directors  (three-year  term): 

Tom  Carey,  M.D.,  Arapahoe 
Robert  Kruse,  M.D.,  Arapahoe 
Susan  Sherman,  M.D.,  Aurora-Adams 
Joel  M.  Karlin,  M.D.,  Clear  Creek  Valley 
Elaine  Norman  Scholes,  M.D.,  Denver 
Robert  A.  Nathan,  M.D.,  El  Paso 
John  B.  Muth,  M.D.,  El  Paso 
Thomas  J.  Allen,  M.D.,  Larimer 
Muryl  L.  Laman,  M.D.,  Pueblo 
Denis  J.  Winder,  M.D.,  Southwest  Rural 
Section  Directors  (one  year  term: 

Stephen  G.  Batuello,  M.D.,  Resident  Physician  Section 


Louise  McDonald,  M.D.,  Women  in  Medicine  Section 

Medical  Student  Component  (one  year  term): 

Theresa  A.  Scholz,  MSIV 

Council  on  Ethical  & ludicial  Affairs  (three-year  term) 

Keith  M.  McDonald,  M.D.,  Arapahoe 

Marilyn  Dougherty,  M.D.,  Boulder 

Herman  E.  Doyle,  M.D.,  Clear  Creek  Valley 

Bernard  E.  Campbell,  M.D.,  Clear  Creek  Valley 

Michael  Victoroff,  M.D.,  Denver 

Sidney  Rubinow,  D.O.,  El  Paso 

John  W.  LaVoo,  M.D.,  El  Paso 

Renate  Justin,  M.D.,  Larimer 

Grievance  Review  Committee  (three  year  term): 

Charlotte  D.  Scanlon,  M.D.,  Arapahoe 

C.  Edward  Heaton,  M.D.,  Aurora-Adams 

Walter  H.  Oppenheim,  M.D.,  Clear  Creek  Valley 

Eugene  Jacobson,  M.D.,  Denver 

David  Shander,  M.D.,  Denver 


C nlnrxrln  \Aprlirinf>  fnr  Drtnhpr  1QQ3 


351 


Annual  Meeting  '93 


Bruce  L.  Reimers,  M.D.,  El  Paso 
Ronal  B.  Mason,  M.D.,  Northwest  Rural 

Speaker  of  the  House  ( two-year  term): 

Stuart  O.  Silverberg,  M.D. 

Vice  Speaker  of  the  House  (one-year  term): 

Ted  T.  Lewis,  M.D.,  El  Paso 

AMA  Delegate  (two  position  to  be  filled  for  a two-year 
term  from  lanuary  1,  1994  to  December  31,  1995): 

M.  Ray  Painter,  Jr.,  M.D.,  Mt.  Sopris 
Mark  Levine,  M.D.,  Arapahoe 

AMA  Alternate  Delegate  (two  position  to  be  filled  for  a 
two-year  term  from  lanuary  1,  1994  to  December  31, 
1995): 

Robert  Bogin,  M.D.,  Denver 

Joel  M.  Karlin,  M.D.,  Clear  Creek  Valley 

NOMINATING  COMMITTEE  1993/94 


Max  Bartlett,  M.D. 

Norman  O.  Aarestad,  M.D. 
Paul  B.  Visconti,  M.D. 


Arapahoe  Medical  Society 
Arapahoe  Medical  Society 
Aurora-Adams  County 
Medical  Society 


Kevin  R.  Berg,  M.D. 

Ronald  E.  Tegtmeier,  M.D. 

Dean  L.  Sadler,  M.D. 

Barbara  Reed,  M.D. 

Robert  Sawyer,  M.D. 

Bonita  Carson,  M.D. 
Marilyn  Gifford,  M.D. 

John  W.  LaVoo,  M.D. 
William  W.  Ezell,  M.D. 

Lee  B.  Goiter,  M.D. 

Jarvis  Ryals,  M.D. 

James  EH.  Peterson,  M.D. 

Richard  L.  Brownrigg,  M.D. 


Boulder  County  Medical 
Society 

Clear  Creek  Valley  Medical 
Soc. 

Clear  Creek  Valley  Medical 
Soc. 

Denver  Medical  Society 
Denver  Medical  Society 
Denver  Medical  Society 
El  Paso  Medical  Society 
El  Paso  Medical  Society 
Larimer  County  Medical 
Society 

Mesa  County  Medical 
Society 

Pueblo  County  Medical 
Society 

Weld  County  Medical 
Society 

Southeast  Rural 


Delegate  Attendance — 1 993  Annual  Meeting 


Affiliation 

Registrant 

Stecher,  Karl  Jr,  MD 

American  College  of  Surgeons  EHildebrand,  Jan  S,  MD 
Arapahoe  Baack,  Judy,  MD 

Thulin,  Barbara  W,  MD 
Varani,  William  B,  MD 

Baker,  L Thomas,  MD 
Bartee,  Roy  M II,  MD 
Bartlett,  Max  D,  MD 
Boulder,  Joel  C,  MD 
Brenneman,  Janice  K,  MD 
Capek,  Richard  B Jr,  MD 
Foss,  Frederick  A Jr,  MD 
Jolly,  Susan  L,  MD 
Larsen,  Lawrence  V,  MD 
Levine,  Mark  A,  MD 

Aurora-Adams  County 

Ashkar,  Louis,  MD 
Buckley,  Jerome  M,  MD 
Capin,  Leslie  R,  MD 
Heaton,  Angeline  D,  MD 
Heaton,  Carl  E,  MD 
Manguso,  Robert  L,  MD 
Rich,  John  D,  MD 
Sundland,  Barry  R,  MD 
Visconti,  Paul  B,  MD 

Lewis,  Frederick  A Jr,  MD 
Ozog,  Mark  F,  MD 
Scanlon,  Charlotte  D,  MD 

Boulder  County 

Benson,  Alan  E,  MD 
Berg,  Kevin  R,  MD 
Curtis,  William  S,  MD 

352 

Colorado  Medicine  for  October,  1993 

Annual  Meeting 


Delegate  Attendance- 

Farrington,  John  F,  MD 
Kelley,  Severance  B,  MD 
Mooney,  Herbert  S Jr,  MD 
Rubright,  Mark  W,  MD 
Rupp,  Gerald  R,  MD 
Williams,  William  J,  MD 
Wilson,  Don  E,  MD 

Clear  Creek  Valley  Brundige,  Richard  L,  MD 

Cedars,  Chester  M,  MD 
Daneshbod-Skibba,  Ghodsi,  MD 
Dorr,  Lugene  A,  MD 
Eaton,  Wyley  E,  MD 
GJellum,  George  R,  MD  PC 
Golbert,  Thomas  M,  MD 
Henbest,  Philip  M,  DO 
Laubach,  Sherri  J,  MD 
Mains,  Charles  W,  MD 
Mann,  James  G,  MD 
Parry,  Lynn,  MD 
Sadler,  Dean  L,  MD 
Tegtmeier,  Ronald  E,  MD 
Yocum,  Harold  A,  MD 


1993  Annual  Meeting 

Cook,  William  R,  MD 
Davis,  Kevin  P,  MD 
Foust,  Glenn  T III,  MD 
Hedberg,  John,  MD 
Hutchison,  David  E,  MD 
Jacobs,  Mary  Jo,  MD 
Karel,  James  L,  MD 
Kelble,  David  L,  MD 
Kinzie,  Jeannie  J 
Manart,  Frank  D,  MD 
McCallum,  Douglas  G,  MD 
McCartney,  Robert  D,  MD 
Nelson,  Nancy  E,  MD 
Owens,  J Cuthbert,  MD 
Reed,  Barbara  R,  MD 
Safford,  H R III,  MD 
Sawyer,  Robert  B,  MD 
Schemmel,  Janet  E,  MD 
Scholes,  Elaine  N,  MD 
Schramm,  Victor  L Jr,  MD 
Sides,  Leroy  J,  MD 
Stigler,  Del,  MD 
Walker,  Louise  Converse,  MD 


Colo  GYN/OB  Society  Rapaport,  Alan  M,  MD  El  Paso  County 

Colo  Soc  of  Clinical  PathologistsStienmier,  Richard  H, 

MD 


Colo  Soc  of  Internal  MedicineClaassen,  David  W,  MD 


Curecanti 


Hopple,  Lynwood  M,  MD 


Delta  County 


Sinclair,  John  C,  MD 


Denver  Anneberg,  A Lee,  MD 

Bakemeier,  Richard  F,  MD 
Ballinger,  Carter  M,  MD 
Barmatz,  Hirsh  E,  MD 
Bogin,  Robert  M,  MD 
Bumgarner,  Frank  E Jr,  MD 
Campbell,  William  A III,  MD 
Carson,  Bonita  S,  MD 


Brusenhan,  J Richard,  MD 
Cole,  Norman  G Jr,  MD 
Crawford,  Lewis  A,  MD 
Emeis,  William  E,  MD 
Feinsod,  Fred  M,  MD 
Genrich,  John  H,  MD 
Gifford,  Marilyn  J,  MD 
Gorab,  Lawrence  N,  MD 
Hanson,  J R,  MD 
LaVoo,  John  W,  MD 
Lloyd,  William  E,  MD 
Moore,  Larry  A,  MD 
Muth,  John  B,  MD 
Rapp,  Alan  D,  MD 
Rubinow,  Sidney  D,  DO 
Sherman,  John  L,  MD 
Simerville,  James  J,  MD 
Spaulding,  Duane  R,  MD 
Struck,  Teresa  H,  MD 


Colorado  Medicine  for  October,  1993 


353 


nnual  Meeting 


'93 


Delegate  Attendance — 1 993  Annual  Meeting 


Fremont  County 

Buglewicz,  John  V,  MD 
Gamache,  Peter  J,  MD 

Huerfano  County 

Unrein,  Christopher  J,  DO 

Larimer  County 

Bush,  James  F,  MD 
Chase,  Jerry  A,  MD 
Ezell,  William  W,  MD 
Giansiracusa,  Richard  F,  MD 
Hammond,  Richard  O,  MD 
Honea,  Bertrand  N III,  MD 
Kaiser,  Dale  C,  MD 
Nemeth,  Clifford  J,  MD 
Sheets,  Ronald  R,  MD 
Stephens,  Floyd  V Jr,  MD 
Tagge,  Gordon  K,  MD 

Medical  Student  Component  Johnson,  Brian  L 

Slenkovich,  Nick 
Wepman,  Carolyn  J 

Mesa  County 

Doran,  John  H,  DO 
Jones,  Paul  B,  MD 
Klein,  M G,  MD 
Linnemeyer,  Robert  F,  MD 
Magraw,  Bronwen  J,  MD 
Sadler,  Theodore  R Jr,  MD 

Montezuma  County 

Fury,  Dianna  L,  MD 

Morgan  County 

Thompson,  Patrick  L,  MD 

Mt.  Sopris  County 

Painter,  M Ray  Jr,  MD 
Rodriguez,  Jose  L,  MD 

Otero  County 

Satt,  James  M,  MD 

Pueblo  County 

Chimento,  James  J,  MD 
Morgan,  Alethia  E,  MD 
Proctor,  Carla  R,  MD 
Roukema,  James  E,  DO 
Ryals,  Jarvis  D,  MD 
Snyder,  Charles  E,  MD 
Tonsing,  Robert  E,  MD 
Tonsing,  Sara  M,  MD 

San  Luis  Valley 

Brownrigg,  Richard  L,  MD 

Weld  County 

Bradley,  Robert  C,  MD 
Flower,  Thomas  J,  DO 
Quinn,  Richert  E Jr,  MD 
Tyburczy,  Joseph  A Jr,  MD 

Women  in  Medicine  Section  Justin,  Ingrid  M,  MD 

Highlights  of  the  Board  of  Directors  Meeting-  September  9, 1993 


Copic: 

Medical  Student 
Component: 

Board  of  Directors: 


Dr.  Howard  introduced  Dr.  Jerome  Buckley  who  has  been  elected  CEO  of  Copic.  Dr. 
Buckley  will  assume  these  duties  upon  Dr.  Howard's  retirement  in  January,  1995 
Ms.  Theresa  Scholz  reported  that  a total  of  1 7 Medical  Students  were  attending  the  Annual 
Meeting. 

The  Board  approved  a request  from  Dr.  Mark  Levine  to  endorse  a People  to  People  study 
mission  project. 

The  Board  referred  a resolution  which  called  for  the  reorganization  of  the  Board  of  Directors 
to  the  Organizational  Study  Committee  (OSC)  for  an  in  depth  review  of  the  duties  and 
powers  of  the  Executive  Committee,  Board  of  Directors  and  House  of  Delegates.  The  Board 
also  instructed  the  OSC  to  hold  open  meetings  in  order  for  members  to  have  the  opportunity 
to  express  opinions  on  this  matter. 

The  Board  approved  the  referral  of  several  late  resolutions  to  the  Credentials  Committee  for 
consideration  at  the  1 993  Annual  Meeting.  These  resolutions  covered  such  topics  as 
restructuring  of  existing  Councils,  sponsorship  of  an  IPA. 


354 


Colorado  Medicine  for  October,  1993 


Annual  Meeting 


What  Next?  Legal  System  Reform? 

Alan  Weil,  Health  Policy  Advisor  to  Governor  Roy  Romer  (ColoradoCare)-  made  the  following  comments  at  the 
Annual  Meeting  Luncheon  sponsored  by  COMPAC  and  the  Colorado  Medical  Society  Alliance. 


I was  on  the  plane  coming  back 
from  Washington  D.C.  to  Denver  last 
night,  and  I fell  asleep,  and  they  say 
you  have  funny  dreams  when  you 
are  at  high  altitudes,  I guess  30,000 
ft.  counts  for  high  altitude.  I had  a 
really  weird  dream.  I had  a dream 
that  suddenly  lawyers  became  the 
most  liked  profession.  I told  you  this 
was  a funny  dream.  But  it  got 
weirder,  people  decided  that  the 
service  that  lawyers  provide  after 
years  of  maligning  them  and  calling 
them  quacks  were  actually  valuable 
and  important,  and  not  only  impor- 
tant to  the  people  who  could  pay  for 
them  and  afford  to  get  a lawyer,  but 
everyone;  everyone  needed  legal 
services.  And  then  people  came  up 
with  another  conclusion,  which  was 
that  this  patch  work  system  of  legal 
aid  and  assistance  and  pro  bono 
work,  that  lawyers  had  developed 
was  not  adequate  to  cover  the  needs 
of  people  who  didn't  have  access  to 
legal  services.  And  suddenly  there 
was  this  cry  for  a reform  of  the  legal 
system,  and  lawyers  had  two  reac- 
tions. One  of  their  reactions  was 
"This  is  terrifying.  I am  a lawyer.  I do 
my  business  everyday.  I try  to  help 
people  . I do  my  job.  And  suddenly 
everyone  wants  a hand  on  what  I do 
and  they  want  to  control  the  work 
that  I do.  And  they  want  to  change 
the  way  I get  paid  for  my  services, 
and  they  want  to  look  over  my 
shoulder."  And  the  other  reaction  I 
had  was  "Isn't  it  great,  people  really 


care  about  what  we  do.  This  is  a 
wonderful  time  for  lawyers.  We've 
been  beaten  down  for  so  long,  and 
suddenly  people  see  value  in  what 
we  do  and  know  that  everyone 
needs  access  to  the  services  that  we 
provide." 

OK,  I made  up  the  dream,  I 
didn't  really  have  it.  But  I am  a 
lawyer  and  I wanted  to  try  to  put  a 
little  of  what  you  are  going  through 
into  terms  that  would  make  a little 
more  sense  to  me. 

It  seems  to  me  that  the  medical 
profession  is  going  through  a time 
that  is  both  terrifying  and  exciting  . 
Everyone  suddenly  cares  tremen- 
dously about  everything  you  do  and 
how  you  get  paid  and  what  you  get 
paid.  But  at  the  same  time  there  is  a 
tremendous  excitement,  I would 
hope,  that  says  people  finally  do  see 
the  importance  of  making  sure  that 
the  services  we  provide  are  available 
to  everyone,  and  not  just  to  those 
who  can  afford  them.  I was  very 
interested  to  read  the  proposed 
resolution  that  you  all  are  looking  at 
during  this  annual  meeting,  where 
you  change  what  you  are  referring  to 
from  health  care  reform  to  health 
system  reform.  And  I though  that  was 
perfect.  I thought  that  was  a perfect 
example  of  an  understanding  that  as 
Governor  Dean  said,  "people  don't 
really  want  a change  in  the  health 
care  they  get,  they  want  a change  in 
the  system  within  which  their  health 
care  is  delivered."  They  are  unhappy 


Alan  Weil,  JD 


about  financing  problems.  They 
don't  understand  the  system  that  they 
live  in.  Their  are  concerned  about 
losing  their  insurance  and  about 
losing  access  to  the  system.  I don't 
want  to  suggest  that  there  are  no 
concerns  about  health  care,  but  I 
really  think  the  key  here  is  the  health 
care  system,  and  the  desire  on  the 
part  of  many  to  change  the  system  of 
health  care  and  health  care  delivery. 

Now,  I told  you  the  little  story 
about  the  dream  in  part  because 
whether  you  believe  it  or  not,  I 
actually  think  that  the  legal  profes- 
sion will  be  the  next  profession  to  go 
through  some  of  the  changes  that 
you  all  face  right  now,  because  the 
legal  profession  has  inserted  itself  so 
centrally  in  the  lives  of  so  many 


Colorado  Medicine  for  October,  1993 


355 


Annual  Meetin 


G 


'93 


Alan  Weil  (cont.) 

people,  and  indeed  many  people 
find  themselves  in  situations  where 
not  having  access  to  legal  services  is 
a real  problem.  And  I do  think  that 
there  is  an  analogy  among  many 
professions  where  members  are 
asked  to  regulate  themselves,  and 
they  build  up,  and  they  build 
credibility,  and  then  they  find  that 
people  actually  want  everyone  to 
have  access  to  those  professional 
services.  So  I say  only  partly  in  jest, 
that  I think  some  of  these  changes 
may  come  to  the  legal  system.  I 
suspect  it  will  be  somewhat  longer  in 
coming. 

I just  want  to  say  a few  thing 
about  what  we  are  doing  in  Colo- 
rado and  a couple  of  things  on  the 
national  level  and  then  I'll  sit  down 
and  there  will  be  more  time  for 
questions  and  discussion.  First  of  all, 

I need  to  say  that  I know  some  of 
you  came  here  expecting  me  to  be 
carrying  a stack  of  reports  on  Colo- 
radoCare,  and  I have  to  apologize,  it 
is  just  not  there  yet.  I think  it  is  going 
to  go  to  the  printer  on  Monday,  that's 
assuming  I decide  not  to  enjoy 
beautiful  Snowmass  for  the  weekend, 
and  instead  get  my  work  done, 
which  I need  to  do.  We  are  just 
about  to  release  a report  on  the 
feasibility  of  ColoradoCare,  but  it  is 
not  out  yet,  and  you  all  will  know 
immediately  when  it  comes  out.  We 
have  been  held  up  a little  by  the 
special  session,  but  that  report  will 
come  out  very  soon. 

I think  you  will  find  that  the 
ColoradoCare  design,  just  as  Gover- 
nor Dean  said  for  months,  is  not 
terribly  different  from  what  we 
expect  to  come  from  the  President.  I 
don't  want  to  suggest  that  they  are 


identical,  because  they  certainly 
aren't.  We  don't  know  all  the  details 
of  what  the  President's  proposal  will 
be.  The  ColoradoCare  report  lays  out 
more  options.  It  doesn't  come  out 
and  say  this  is  the  answer;  it  says 
here's  some  different  ways  of  doing 
things.  Hopefully  that  will  lead  to 
some  reaction.  But  I just  need  you  to 
know  that  I know  it  is  not  ready  yet; 
believe  me,  we'll  get  the  report  out 
very  quickly. 

The  other  thing  I wanted  to  say 
at  the  state  level  is  that  the  scenario 
that  I laid  out  for  lawyers  suggests  a 
need  on  the  part  of  professionals, 
and  I know  you  all  have  heard  this 
before,  but  the  need  on  the  part  of 
professionals  who  give  services  and 
deliver  services  to  be  involved  in  the 
process  of  changing  the  system 
within  which  they  work.  I think  there 
are  many  opportunities  for  that.  I 
think  we  have  tried  to  be  very  open 
at  the  state  level  in  our  reform  efforts 
to  conversations  and  concerns  being 
raised  by  physicians.  So,  I do 
encourage  the  participation,  not  that 
it  needs  encouragement,  of  those 
who  will,  as  Governor  Dean  said,  by 
those  who  will  be  most  effected  by 
the  reform. 

Let  me  just  say  a couple  of  things 
about  the  national  efforts.  I think  Mr. 
Robers  description  of  the  President's 
plan  is  accurate  from  everything  I 
have  seen.  The  only  question  I 
would  raise,  it  may  be  that  the 
Federal  Government  doesn't  try  to 
cap  damages  under  malpractice,  but 
I would  be  very  surprised  if  they 
prevented  states  from  doing  that;  that 
would  really  surprise  me.  And,  after 
all,  tort  law  is  all  state  law,  so  I think 
it  is  a little  questionable  whether  or 


not  the  Federal  Government,  appro- 
priately, should  step  in  and  change 
the  laws  that  exists  in  50  states,  even 
if  substantially  it  is  the  right  thing  to 
do.  Politically  it  may  not  be  appro- 
priate for  the  Federal  Government  to 
take  over  that  much  of  state  tort  law. 

With  that  said,  I do  think  that  the 
description  is  fairly  accurate,  and  I 
would  really  only  raise  two  issues: 
One  is  the  financing.  I read,  as  I said, 
your  statement  on  health  care 
reform,  and  I see  in  it  a very  strong 
commitment  on  the  part  of  the 
medical  society  for  universal  health 
insurance  coverage.  I think  that's 
great.  And  you  go  out  to  almost  any 
organization  that's  weighing  in  on 
health  care  reform,  and  they  say  "we 
support  universal  coverage  for  health 
care."  Not  everyone,  but  almost 
everyone  says  that.  And  I see  your 
section  on  financing,  and  again,  I 
think  it  is  exactly  right,  which  is  that 
all  of  the  burden  should  not  fall  on 
one  sector;  don't  just  do  provider 
taxes;l  liked  that  one,  and  you  know 
we  need  a mixed  system  of  financ- 
ing. I think  that  is  right  too.  But  I 
have  one  thing  that  I want  to  toss  out 
there,  which  is,  if  you  really  believe, 
really  really  believe,  in  universal 
access  to  health  insurance,  you  can't 
just  take  the  proposal  that  comes  out 
and  tell  us  everything  that's  wrong 
with  it.  You  have  to  actively  support 
a financing  method.  I mean  actively. 
There  are  many  organizations  that 
will  actively  oppose  the  financing 
mechanism.  And  all  I am  trying  to 
make  clear  to  everyone  is  that  if  you 
want  a package,  everyone  has  to 
give  a little;  we  all  know  that.  But 
you  can't  just  look  at  the  areas  that 
are  uncomfortable;you've  got  to  pick 


356 


Colorado  Medicine  for  October,  1993 


areas  that  you  agree  with  and  push 
on  them.  And  again,  I really  chal- 
lenge you  and  other  organizations;  if 
you  want  to  see  it  happen,  you've 
got  to  be  positive  about  some  of  the 
features.  The  hardest  feature  is  going 
to  be  how  to  pay  for  it.  I am  not 
suggesting  that  everyone  should  gang 
up  on  some  poor  soul  who  is  going 
to  have  to  pay  all  of  the  800  and 
something  billion  dollars  we  pay  for 
health  care,  but  I do  think  that  you 
just  can't  be  agnostic  about  a piece 
of  the  plan  that  is  so  critical.  If  you 
want  to  suggest  changes,  if  you  want 
to  suggest  alternatives,  more  power 
to  you,  but  I suggest  to  you  that 
silence  on  financing  is  enough  to  kill 
the  proposal. 

The  second  thing  I wanted  to  say 
to  you  is  something  about  budgets 
and  cuts  in  Medicare  and  Medicaid. 

I am  personally  not  a big  fan  of 
budgets.  In  fact,  I think  you  will  see 
in  the  ColoradoCare  report  that 
ColoradoCare  has  evolved  some 
from  its  original  incarnation,  into 
something  that  is  much  less  reliant 
upon  a budget.  I frankly  am  con- 
cerned about  the  federal  government 
setting  budgets  on  health  care.  It 
does  not  appeal  to  me.  But  there  is  a 
problem  with  just  saying  that  we 
opposed  them  all.  The  problem  is 
that  the  reasons  we  have  financing 
issues  relating  to  Medicare  and 
Medicaid  are  because  we  create 
entitlements  to  services,  and  then  we 
spend  as  much  as  we  have  to  spend 
to  give  everyone  those  services.  It  is 
only  after  20  something  years  of 
increases  , first  slow  and  then  very 
rapid,  that  people  start  saying  that 
we  can't  afford  this  anymore.  We 
can't  afford  to  have  that  happen  with 


the  health  care  system  that  everyone 
is  in.  It  is  bad  enough  that  it  is 
happening  in  a system  that,  don't 
forget,  20%  of  Americans  are  in 
Medicare  or  Medicaid,  this  is  not 
some  small  program  off  to  the  side,  it 
is  a fifth  of  the  population  or  slightly 
more.  We  can't  write  a blank  check 
that  says  everyone  is  entitled  to  a 
benefit  package,  and  we  will  figure 
out  how  to  pay  for  it  somewhere 
down  the  road. 

I am  a firm  believer  that  com- 
petitive force  within  the  market  will 
bring  about  significant  changes  and 
reductions,  at  least  in  the  rate  of 
growth  in  premium  costs.  I think  that 
the  market  can  do  a great  deal  here, 
and  that's  why  I prefer  not  to  go  in 
the  direction  of  budgets.  But  I think 
you  have  to  understand  what  you  are 
arguing  for  if  you  say  that  there 
should  be  no  budget  on  the  system. 
What  you  are  saying  is  that  every 
single  American  has  access,  has  the 
right  to  demand  this  set  of  services, 
and  some  day,  somewhere,  we  will 
figure  out  how  to  pay  for  it.  It  may  be 
low  this  year,  and  it  may  be  pretty 
good  next  year,  because  we  will  get 
some  consolidation  and  savings,  but 
I don't  think  it  is  sustainable  in  the 
long  run.  There  may  be  other  ways 
to  put  limits  on  the  system.  Governor 
Dean  referred  to  the  Oregon  ap- 
proach, which  again  I have  problems 
with.  I am  not  suggesting  that  there  is 
a great  solution  to  this.  All  I am 
saying  to  you  is  that  I think  you  have 
to  be  very  thoughtful  about  whether 
or  not  it  is  appropriate  to  ask  the 
American  people  to  write  a check 
where  they  don't  know  what  the  size 
is  going  to  be  in  that  amount  box. 
One  of  the  things  that  the  single 


payer  folks  have  said  is,  you  know, 
"just  get  off  our  back,  but  tell  us  how 
big  the  check  is".  I am  not  an 
advocate  of  that  approach.  But  there 
is  logic  to  it,  that  says  we  will  fight  it 
out  amongst  ourselves,  but  we  will 
tell  you  ahead  of  time  how  much  we 
are  going  to  ask  you  to  spend.  Again, 
that  is  not  my  preferred  approach, 
but  I think  you  need  to  understand 
that  particularly  when  you  are 
talking  about  a seventh  of  the 
economy,  for  it  to  become  a sixth 
and  a fifth  and  a quarter,  and  those 
numbers  are  not  unrealistic,  that 
people  are  going  to  say  wait  a 
minute.  I would  rather,  and  this  is 
really  the  final  point  I am  going  to 
make,  I would  rather  we  be  thought- 
ful now  about  how  to  place  some 
limitations  on  that  system  so  it 
continues  to  function  into  the  future, 
than  that  we  pretend  that  we  don't 
have  to  place  any  limits  on  it,  and 
then  end  up  with  a Medicaid  situa- 
tion like  we  have  now  where  it  is 
preventing  us  from  investing  in 
schools  or  violence  prevention  or 
any  of  the  other  things  that  we  feel 
the  need  to  spend  money  on.  So, 
don't  lock  yourselves  into  "this  has 
to  be  the  budget",  but  don't  assume 
that  you  can  walk  away  from  any 
responsibility  for  placing  some  limits 
on  the  total  costs  of  the  system. 

Those,  I think,  are  big  issues. 
Obviously  there  are  dozens  and 
dozens  of  smaller  ones,  but  I think 
that  if  we  can  solve  some  of  these 
bigger  ones,  and  reach  agreement  on 
them,  we  ought  to  be  able  to  tackle 
some  of  the  others. 

Thanks! 


Annual  Meeting 


'93 


The  Corporatization  of  Health  Care 

Lonnie  R.  Bristow,  MD,  Chairman  of  the  AMA  Board  of  Trustees , made  these  remarks  during  the  educational  program 

at  the  Annual  Meeting  of  the  Colorado  Medical  Society  in  Snowmass.  Village,  Colorado 


Lonnie  R.  Bristow,  MD 


It's  an  honor  to  be  here  with  you, 
and  to  talk  with  you  about  the 
changing  face  of  medicine.  There 
could  not  be  a more  opportune 
moment. 

In  less  than  two  weeks,  the 
President  will  be  unveiling  his  health 
plan  in  an  address  to  a joint  session 
of  Congress.  Already,  in  some  form, 
or  in  some  forum,  many  of  the 
details  are  being  announced,  or 
leaked,  or  circulated.  Our  direction 
for  the  future  is  not  clear,  but  it  is 
getting  clearer.  Changes  already  are 
in  motion  The  marketplace  isn't  even 
waiting  for  the  President;  it's  reform- 
ing itself,  almost  spontaneously,  as  if 
to  say  "Catch  me  if  you  can". 

Just  look  at  managed  care  and 
HMOs.  The  first  HMOs  were  formed 
way  back  in  the  1930s  and,  in  the 
years  since,  most  physicians  spurned 
them.  Now,  50  years  later,  HMOs 
have  come  to  prominence  as  a major 
means  of  health  care  delivery. 
Nationwide,  over  one  quarter  of  all 
Americans  turn  to  health  mainte- 
nance organizations  for  their  health 
care.  But  that  kind  of  trend  is  just  a 
blip  on  the  screen  against  the  major 
trends  now  at  work,  because  the 
entire  system  is  reforming  itself. 

States  like  Florida,  Hawaii,  Kentucky, 
Maryland,  Minnesota,  and  Vermont 
— are  all  trying  out  ideas  which 
have  national  implications. 

Meanwhile  — in  the  world  of 
hospitals  — mergers,  consolidations 
and  cutbacks  are  the  rule  of  the  day. 
Giant  insurance  combines  are 


moving  to  capture  large  segments  of 
the  market  — terms  like  "vertical 
integration"  are  becoming  as  familiar 
as  "solo  practitioner".  And  managed 
care  networks  are  popping  up  in 
every  community.  You  don't  need 
me  to  tell  you  that  physicians 
everywhere  are  feeling  the  impact. 
Government,  in  fact,  is  going  to 
arrive  late  on  the  scene  of  change. 

But  what  do  these  new  market- 
place relationships  mean?  What  are 
the  new  roles  that  all  of  us  — 
doctors,  hospitals,  insurers,  patients 
— what  are  the  new  roles  we're 
being  called  on  to  play?  Redefinition 
is  coming  so  fast  that  there  is  no  time 
to  consult  the  handbook.  Look 
around  you. 

CIGNA,  for  instance,  has  always 
been  one  of  the  insurance  giants.  But 
recently  in  New  York  they  have 
become  a managed  care  giant  as 
well.  Says  their  CEO,  Larry  English: 
"We  are  rapidly  moving  from  the 
insurance  business  to  becoming  a 
health  care  delivery  system".  We 
take  that  statement  at  face  value 
today;  1 0 years  ago  it  would  have 
shocked  us.  But  if  we  are  talking 
about  survival  in  the  health  care 
jungle  today,  it  is  indeed  survival  of 
the  fittest;  not  necessarily  the  finest, 
but  certainly  the  fittest.  And,  as  these 
huge  consolidated  health  provider 
systems  are  proving,  the  quickest 
way  to  assert  their  fitness  is  to 
dominate  the  market.  If  current 
trends  continue,  a handful  of  giant 
conglomerates  are  going  to  do  just 


358 


Colorado  Medicine  im  Orlober.  1993 


Annual  Meeting  '93 


that.  And  unless  they  provide 
adequate  information  for  those  who 
must  choose  between  them,  they  run 
the  risk  of  reducing  health  care  to 
just  another  consumer  choice  for 
patients,  just  another  product  choice 
and  in  many  cases,  without  even  the 
benefit  of  brand  loyalty.  Of  leaving 
them,  in  advertising  terms,  to  choose 
a plan  based  on  whether  they  are 
part  of  the  Pepsi  Generation,  or  those 
who  still  think  Coke  Is  It! 

And  they  leave  doctors  wonder- 
ing, whatever  the  brand  is,  whether 
their  glass  is  half  empty  or  half  full, 
whether  the  reduction  in  hassles 
offsets  the  loss  of  clinical  autonomy, 
whether  the  incentives  of  the  new 
systems  are  more  responsible  or 
more  pernicious  than  the  incentives 
of  old. 

We  have  to  find  ways  to  come  to 
terms  with  these  issues,  not  only 
because  we  as  doctors  don't  want  to 
see  our  profession  de-humanized, 
commercialized,  "corporatized",  if 
you  will,  our  relationships  with 
patients  become  a commodity  to  be 
brokered  anew  at  each  open  enroll- 
ment season,  but  because  our 
patients  by  and  large  have  told  us 
that  is  not  the  style  of  medicine  they 
want,  either.  They  tell  us  that 
managed  care  is  fine  for  many  if  not 
most  of  them,  but  that  they  resent  a 
system;  they  don't  trust  a system 
from  which  the  personal  element  is 
removed,  where  they  have  to  shop 
for  a doctor,  often  with  nothing  more 
than  a word  from  a co-worker,  that 
this  "doc"  or  that  one  was  pretty 
good  with  Aunt  Sally.  And  it  is  true 
that  not  everybody,  patients  or 
doctors,  has  the  same  needs.  To  go 
back  to  the  food  and  beverage 
analogy,  some  of  us  prefer  steak 


C nlnrarln  Mpdirinp  fnr  Ortnhpr 


tartare,  and  some  of  us  would  rather 
have  a good  burger  well  done,  and 
that's  not  to  imply  value  judgment 
on  either  one.  It's  only  to  say  that  the 
physician  about  to  retire  after  years 
of  practice  has  very  different  con- 
cerns from  the  young  doctor,  just  out 
of  training,  who  has  to  service  a 
$40,000  debt  load.  And  the  con- 
cerns, perhaps  even  the  needs,  of  a 
young  and  relatively  healthy  patient, 
just  starting  out  and  with  a limited 
salary,  are  going  to  be  different  from 
those  of  an  older  patient,  maybe  one 
who's  had  some  heart  trouble,  who 
needs  the  reassurance  of  continuity 
in  care.  Patients  come  out  consis- 
tently on  this  one  issue,  they  want 
the  freedom  to  choose  their  doctor 
and  their  health  plan,  but  what 
nobody  is  telling  them,  and  perhaps 
what  nobody  is  really  making  very 
clear  to  us,  is  that  once  you  are 
within  the  confines  of  one  of  these 
health  delivery  behemoths,  you  are 
not  dealing  with  the  same  old 
doctor-patient  relationship  any  more, 
because  a doctor  who  works  for  an 
insurance  combine  works  for  that 
insurance  combine  and  shares  the 
same  bottom  line  in  the  end. 

We  can't  forget  that  insurers  and 
hospitals  are  businesses,  and  there's 
a difference  between  a business  and 
a profession.  There's  a basic  truism 
— that  he  who  pays  the  piper  calls 
the  tunes.  That's  going  to  hold  true 
for  whoever  is  paying  that  piper.  If 
it's  an  outfit  that  has  always  been 
concerned  first  with  controlling 
costs,  that's  what  we're  going  to  see 
writ  large  across  the  face  of  our 
relationships  with  patients.  The  profit 
motive  is  a legitimate  motive,  but  it 
has  no  place  in  the  treatment  room. 
And  it  must  never  be  allowed  to 


i 993 


interfere  with  necessary  care, 
because  as  Hillary  Clinton  put  it 
when  she  addressed  the  AMA  House 
of  Delegates  in  June,  "There  is  no 
master  checklist  that  can  be  adminis- 
tered by  some  faceless  bureaucrat 
that  can  tell  you  what  you  need  to 
do  on  an  hourly  basis  to  take  care  of 
your  patients.  And  frankly,  I wouldn't 
want  to  be  one  of  your  patients  if 
there  were". 

But  it's  not  the  same  doctor- 
patient  relationship  any  more;  it  is 
not  the  same  physician-hospital, 
physician-insurer,  or  even  physician- 
physician  relationship  anymore 
either.  There  are  constraints  on  who 
we  may  consult  with,  sometimes 
what  procedures  we  can  use.  How 
long  those  in  our  care  can  remain  in- 
patients and  still  have  their  care 
provided  for.  It  is  the  entire  health 
system  that  is  changing,  that's  taking 
part  in  the  new  networks.  Twice  a 
week,  since  1936,  the  American 
Hospital  Association  has  been 
publishing  its  magazine  year  in  and 
year  out,  under  the  name  of  "Hospi- 
tals". Just  this  June,  after  more  than 
half  a century,  they  changed  that 
name,  to  "Hospitals  and  Health 
Networks". 

"Hospitals  and  Health  Net- 
works". That  (name  change)  is  a real 
sign  of  the  times,  because  up  until 
now,  hospitals  have  not  had  patients. 
They  have  had  doctors,  and  it's  the 
doctors  who  have  the  patients.  And 
doctors  have,  at  most,  perhaps  been 
gathered  in  small  group  practices, 
often  huddled  in  fear  against  the 
threat  of  anti-trust,  and  have  tried  to 
go  it  essentially  alone,  with  just  their 
admitting  privileges  to  bolster  them, 
and  their  knowledge  that  doctors  and 
insurers  historically  have  had  a good 


359 


Annual  Meeting 


' 9 3 


Bristow  ( cont .) 


relationship,  working  together  to 
bring  the  best  health  care  in  the 
world  to  patients  who  needed  it. 

Very  few  of  us  anymore  can  afford 
that  professional  lifestyle,  that 
traditional  practice  style.  We  can't 
afford  it  in  the  most  literal  terms 
because  health  care  inflation  has 
caught  us  too,  and  we  need  the 
hospitals  and  the  large  managed  care 
operations  to  help  defray  some  of  the 
overhead,  to  provide  us  with  facili- 
ties and  administrative  guidelines. 
And  the  hospitals  and  insurers  need 
us,  too.  Just  as  we've  told  the 
Administration  over  and  over  that 
reform  will  not  work  without  the 
input  and  the  participation  of 
doctors,  neither  will  the  networks. 

At  the  current  rate  of  consolida- 
tion, it  will  not  be  long  until  entire 
states  are  dominated  by  a few 
provider  groups.  New  York  in 
particular,  where  they  are  saying 
there  will  be  just  seven  or  eight  plans 
statewide,  just  five  years  from  now. 
It's  not  the  Clinton  reform  that's 
doing  this,  and  it's  certainly  not  the 
marketplace  reforms  in  the  AMA's 
plan,  Health  Access  America.  It's 
what  you  and  I as  an  industry  — the 
health  care  industrial  complex  — are 
doing  to  ourselves  out  of  fear  and 
uncertainty  and  a desperate  attempt 
to  survive  not  "the  health  care 
jungle"  but  the  economic  sands  of 
our  shifting  time.  The  smaller 
insurance  companies  are  afraid.  The 
big  ones  have  moved  into  health 
care.  Teaching  hospitals  are  afraid., 
and  community  hospitals  are  ex- 
panding out  into  their  communities, 
buying  practices  and  pushing 
prevention.  Finally,  I don't  have  to 
tell  you,  doctors  are  afraid.  Some 
look  at  managed  care  as  a godsend 


(people  who  have  a true  love  of 
healing  but  are,  perhaps,  members  of 
two-career  families,  or  who  find 
themselves  in  environments  where 
they  can  exercise  their  true  health 
care  conscience).  For  other  physi- 
cians, the  thought  of  becoming  an 
employee  is  overwhelming,  but  who 
see  no  alternative  for  themselves  as 
the  market  squeezes  tighter  and 
tighter,  as  the  competition  becomes 
more  vigorous,  perhaps  even  more 
vicious.  Out  of  fear,  some  of  them 
signing  33-year  contracts  with 
managed  care  organizations  in  a 
society  where  fewer  and  fewer 
employees  are  remaining  with  their 
corporations  ten  years,  or  even  five. 

If  this  is  the  corporatization  of 
medicine,  we  must  learn  to  make  our 
working  relationships  stronger.  We 
must  learn  the  language  of  hospital 
boards  and  claim  reviewers  and 
contract  negotiation,  but  in  delicate 
balance  with  our  conscious  role  as 
patient  advocates,  knowing  when  to 
serve  Maimonides,  and  when  to 
serve  mammon  — because  by 
putting  money  at  the  bottom  line  we 
bow  to  the  economic  incentive  to 
shortchange  care  when  what  we  are 
as  doctors,  first  and  foremost,  we  are 
patient  advocates,  healers  of  the  sick. 
We  are  trained  in  mind,  committed 
in  practice,  sworn  — yes,  sworn  — 
by  oath.  Now,  here  we  are  with  a 
few  notable  exceptions,  like  Kaiser 
and  Mayo,  we  are  somewhat  "play- 
ers-come-lately"  to  the  network 
game,  still  learning  how  to  form 
networks  and  be  ever  weary  of  anti- 
trust violations,  still  reconciling 
quality  of  care  versus  cost  contain- 
ment, still  wondering  whether  we 
can  sustain  the  risk  one  month  or 
two,  or  three  more,  on  our  own.  We 


all  say  that  medicine  must  not 
become  a "one  size  fits  all"  profes- 
sion, but  as  the  combines  get  larger, 
the  reality  emerges,  and  you  discover 
small  groups,  like  one  in  Minneapo- 
lis which  has  existed  since  1916. 

And  here  is  what  one  of  the  partners 
recently  said:  "We'll  be  history  by 
the  end  of  the  year."  And  he  went  on 
to  say  "There's  no  question  - we'll 
sell  our  practice  or  be  bought  out". 
Case  closed.  That  simple.  That  cut 
and  dried.  And  I'll  tell  you,  the  AMA 
viewpoint  is  that  there  has  to  be 
room  for  every  kind  of  practice,  and 
when  we  talk  about  letting  the 
marketplace  make  the  decisions, 
we're  not  necessarily  talking  about 
engineering  the  marketplace  to 
anticipate,  perhaps  even  obviate, 
reform.  We're  talking  about  patients 
and  doctors  making  informed 
choices.  That's  why  the  AMA  is 
offering  physicians  something  we 
call  our  "Medicine  In  Transition 
Program".  Its  purpose:  to  educate 
physicians  about  the  impact  man- 
aged care  is  going  to  make  on  their 
professional  choices,  so  that  they  can 
successfully  chart  their  own  course 
on  the  waters  of  reform.  Its  makeup: 
it  has  four  components.  First,  a 
managed  care  publications  series 
including  books  and  videotapes  with 
practical  information,  with  new 
materials  released  every  month. 
Second,  special  programming  on 
American  Medical  Television, 
including  a four-part  educational 
series  called  "Medicine  In  Transi- 
tion", and  special  coverage  of  the 
Clinton  plan  as  it  is  unveiled.  The 
third  component,  available  only  to 
AMA  members,  is  the  managed  care 
workshops  provided  on  a local  basis, 
offering  hands-on  experience  with 


360 


Colorado  Medicine  for  October,  1 9_91 


Annual  M 


issues  like  negotiating  contracts.  And 
finally,  the  other  special  member 
service,  a national  physician  advi- 
sory network  of  attorneys  and 
consultants,  the  intention  being  to 
provide  an  affordable,  nationally- 
credentialed  response  to  legal 
questions  and  practice  issues, 
because  the  network  also  includes 
physicians  who  provide  "peer-to- 
peer"  consultations  about  how  they 
adjusted  to  and  prospered  in  the 
managed  care  environment. 

The  AMA  is  the  leader  in 
preparing  our  profession  for  change. 
We  are  less  than  two  weeks  out  from 
reform,  and  I will  tell  you  even  with 
all  the  access  we've  had  to  the 
process,  more  than  any  other  group, 
it  is  still  impossible  to  say  what  the 
future  of  medicine  in  America  will 
look  like  when  that  future  arrives. 

But  I know  for  a certainty  what  the 
heart  and  soul  of  medicine  will  be:  it 
will  be  the  same  as  it  always  has 
been  - the  doctor-patient  relationship 
- that's  the  big  picture;  that's  what's 
defined  the  practice  of  medicine 
since  antiquity,  and  nothing  is  going 
to  change  that.  It's  the  doctor-patient 
relationship  that  keeps  the  real 
quality  in  health  care,  and  when  the 
patient  and  doctor  continue  in 
partnership,  working  as  a team  to 
restore  health,  or  even  simply  to 
safeguard  it,  it  ultimately  cuts  cost  as 
well.  But  more  than  any  of  that,  for 
us  as  physicians,  it's  the  relationship 
itself  that  is  the  reward  of  our 
profession,  it's  what  originally  drew 
all  of  us  to  this  ancient,  venerated, 
even  beloved  healing  art  we  prac- 
tice. It  is  the  relationship  with  our 
patients,  the  personal  investment  in 
their  care,  the  assurance  that  we  are 
doing  the  best  by  them,  and  seeing 
them  through  to  good  health.  We 

Colorado  Medicine  for  October, 


E ET I N G 


can  be  the  good  Samaritans  helping 
the  stranger  by  the  roadside,  ships  in 
the  night  passing  each  other  by  the 
beacon  light  of  ambulance  and 
emergency  room  glare,  but  we  can 
also  share  those  kinds  of  precious 
moments  that  hold  such  a public 
reverence  that  they  have  become 
part  of  the  cliche,  part  of  the  very 
definition  of  doctor,  the  one  who 
cares  for  a family  through  each 
illness,  delivers  each  generation  of 
children,  attends  at  the  bedside  of 
the  dying,  shares  in  the  triumph  of 
recovery.  Even  in  the  best  of  cases, 
not  many  of  us  are  around  that  long 
any  more  - not  with  any  one  patient 
or  family.  And  that's  what  we  have 
to  consider  when  we  think  about  the 
"corporatization"  of  medicine  in  the 
same  way  we  think  about  the 
corporatization  of  America.  This  has 
become  a more  mobile,  temporary, 
dollar-driven  society.  Unfortunately, 
it  is  at  least  in  some  measure  inevi- 
table that  health  care  should  have  to 
follow  it  down  that  same  road,  but  if 
we  have  a choice  to  make,  and  new 
relationships  to  build,  we  can't  let  it 
be  by  the  law  of  the  jungle.  We  can't 
"monkey"  with  what's  best  with 
health  care  now.  We  can't  violate 
the  trust  of  those  in  our  care.  That 
jungle  out  there  will  need  no  small 
measure  of  "environmental"  steward- 
ship. To  be  a responsible  corporation 
that  puts  back  into  the  "environ- 
ment" at  least  as  much  good  as  we 
pull  out  of  it,  and  we,  as  physicians, 
will  have  to  learn  to  relate  to  all  the 
species  out  there,  so  that  the  climate 
of  trust,  the  habitat  of  healing,  may 
survive  and  flourish  for  the  sake  of 
our  profession. 


SMALL 

PHONES 


SMALL 

PRICES 

• Motorola  Equipment 

• Cellular  Accessories 

• On-Site  Installation 

• Competitive  Airtime  Plans 

• Phone  Numbers  Available  — 
Same  Day 

(303)  756-3200 


CELLULAR  CONSUUAN1S  UD. 


Authorized  Agent  ol 

LI£WEST 


CELLULAR 


1993 


361 


Health 


System 


Reform 


by  Robert  M.  Bogin,  M.D.,  Chair 
Health  Systems  Reform  Committee 

and 

Jo  Parkin,  Program  Director 
Division  of  Health  Care  Financing 


CMS  has  expanded  its  position  statement  on  health  system  reform  in  anticipation  of  reform  proposals  being 
released  both  on  a state  and  national  level.  The  expanded  policy  will  help  CMS  leadership  respond  more  quickly  and 
effectively  to  reform  proposals  as  they  are  introduced. 

After  months  of  discussions,  the  Health  System  Reform  Committee  and  the  Board  of  Directors  introduced  Res  52- 
P to  the  House  of  Delegates  at  the  Annual  Meeting  in  September.  The  resolution  supporting  incorporation  of  CMS 
managed  care  policy  into  any  statewide  health  system  reform  proposal  and  amending  existing  CMS  policy  regarding 
health  system  reform  was  adopted.  Following  is  the  recently  amended  CMS  policy  regarding  health  system  reform  as 
it  was  adopted  by  the  House  of  Delegates  in  September. 


Colorado  Medical  Society  Guidelines  for  Health  System  Reform 


Preamble 


Universal  Coverage 


The  Colorado  Medical  Society  (CMS)  believes  that  a universal  health 
insurance  proposal  is  needed  which  would  provide  coverage  for  all  Colorad- 
ans. Benefit  packages  would  be  provided  by  private  insurers.  The  program 
would  be  financed  by  multiple  sources  and  privately  administered.  The  goal 
of  health  system  reform  must  be  to  allow  all  residents  access  to  the  most 
appropriate  site  of  care. 

In  developing  the  following  statements,  CMS  has  taken  into  consider- 
ation what  it  believes  are  a number  of  fundamental  issues  that  should  under- 
score the  discussion  on  improving  the  health  care  system.  We  have  identi- 
fied seven  basic  categories,  1)  Universal  Coverage,  2)  Benefit  Package,  3) 
Funding,  4)  Administration,  5)  Quality  Control,  6)  Cost  Control,  and  7) 
Externalities.  Each  of  these  categories  is  listed  below,  followed  by  the 
relevant  specific  points  which  build  upon  each  category.  These  points  are 
designed  to  accomplish  the  goal  of  expanding  access  to  affordable  quality 
health  care  to  all  Coloradans,  to  preserve  the  strengths  of  our  current  system, 
and  most  importantly,  to  remain  as  patient  advocates  rather  than  as  agents  of 
the  government  or  other  third  parties. 

It  is  imperative  that  the  medical  profession  participate  in  the  health 
system  reform  process  as  it  evolves.  These  guidelines  provide  an  outline  of 
CMS  positions  on  fundamental  issues  regarding  health  system  reform  and 
should  be  reviewed  on  an  ongoing  basis.  Therefore,  this  document  should 
be  considered  a working  document  that  will  be  modified  as  the  health  system 
reform  process  progresses  and  as  new  information  becomes  available. 


All  Colorado  residents  should  be  assured  affordable  coverage  of  their 
appropriate  health  care  costs  regardless  of  their  health  or  employment  status. 
The  term  "resident"  must  be  precisely  defined,  and  then  coverage  extended 
to  all  residents,  regardless  of  whether  they  seek  the  benefit  or  not.  Such 
definition  must  include  solutions  to  the  difficult  questions  of  part-time 
residents,  transients,  new  residents,  residents  whose  employers  are  located 
out-of-state,  federal  employees,  and  residents  who  are  difficult  to  identify 
because  they  file  no  regular  forms  with  a state  agency. 


Policies  regarding  residency  requirements  should  discourage  people  from 


362 


Colorado  Medicine  for  October,  1993 


Health 


System 


moving  to  Colorado  specifically  to  obtain  health  care  coverage.  A combina- 
tion of  public  and  private  cost  sharing  should  be  used  to  cover  people 
ineligible  for  coverage  due  to  residency  requirements. 

CMS  believes  that  a universal  health  plan  for  the  citizens  of  Colorado 
must  address  the  Medicare  eligible  population,  Medicaid,  automobile 
insurance,  Workers'  Compensation,  and  other  coverage. 


Universal  Coverage 
(cont.) 


Portability 

It  is  imperative  that  individuals  be  allowed  to  keep  their  coverage  if  they 
move  from  job  to  job  within  the  state.  Any  plan,  however,  should  include 
definitions  for  the  treatment  of  coverage  when  residents  travel  out  of  the 
state.  The  treatment  of  employees  of  interstate  business  must  also  be  ad- 
dressed. 

Pre-existing  Conditions 

The  current  insurance  industry  practice  of  excluding  coverage  to  indi- 
viduals because  of  pre-existing  conditions  must  be  eliminated. 


Basic  Benefits 

The  identification  of  a basic  core  of  minimum  benefits  to  be  available  to 
all  Colorado  residents  is  a necessary  element  in  any  comprehensive  health 
system  reform.  The  package  should  include  the  following: 

• Preventive  Medicine: 

Coverage  for  preventive  medicine  should  be  emphasized  and 
included.  Preventive  medicine  would  include  but  not  be  limited  to 
prenatal  care,  immunizations,  well-baby  care  and  routine  screening. 

• Multi-Tier  System: 

A multi-tier  system  should  be  made  available.  This  system  would 
provide  for  a basic  benefit  package  for  all  Coloradans  with  an  option 
for  the  citizens  to  purchase,  with  their  own  funds,  additional  ben- 
efits. 

• Freedom  of  Choice — 

Discussion  on  this  topic  centers  around  two  fundamental  issues: 
Patient  Choice  and  Physician  Choice. 

— Patient  Choice: 

A cornerstone  in  our  current  system  is  the  individual  patient's 
freedom  of  choice  to  select  his  or  her  own  physician  and  to 
pursue  services  which  meet  his  or  her  health  care  needs.  Free- 
dom of  choice  by  patients  to  choose  their  physician  through 
their  health  plan  should  include  the  freedom  of  choice  of 
patients  to  choose  a specialist  of  their  selection.  If  the  specialist 
is  not  in  that  specific  health  plan,  access  to  that  physician  should 
be  permitted  through  a point  of  service  option1.  Quality  care 
must  be  assured  both  in  and  outside  of  the  networks. 


Benefit  Package 


Colorado  Medicine  tor  October.  1993 


363 


Benefit  Package 
(cont.) 


Funding 


Administration 


— Physician  Choice: 

Freedom  of  choice  can  also  be  defined  as  the  right  of  any 
physician,  who  meets  the  requirements  of  any  authorized  plan, 
to  participate  in  that  plan.  CMS  is  concerned  about  physicians 
being  inappropriately  excluded  from  participation  in  plans. 
Health  plans  have  a right  to  set  standards  for  entry  into  or 
continuation  in  their  provider  panels.  Based  on  those  standards, 
they  are  entitled  to  select  with  whom  they  will  or  will  not 
contract.  These  standards  must  be  made  public  and  available  to 
physicians  prior  to  applying  for  membership  on  a panel.  Physi- 
cians who  are  denied  access  into  a panel  or  terminated  from  it 
must  have  the  right  to  an  appeal  process. 

Self-regulation  is  a key  aspect  of  physician  freedom  of  choice. 
Antitrust  laws  must  be  changed  to  allow  physicians  to  police 
themselves  in  an  effort  to  guarantee  the  highest  quality  care. 


The  Colorado  Medical  Society  is  very  concerned  about  the  ability  to 
achieve  appropriate  and  adequate  funding  for  any  health  system  reform 
proposal.  Any  universal  health  plan  should  cease  to  exist  if  it  operates  on  a 
deficit  budget.  We  must  know  more  about  costs  before  we  can  assume  that 
any  health  system  reform  proposal  will  work  well.  There  are  uncertainties  as 
to  the  level  of  taxation  and  the  kind  of  taxes  to  be  used  as  the  revenue 
sources,  but  CMS  makes  the  following  recommendations  with  respect  to 
funding: 

Multi-Source  Revenue  Base 

Funding  for  any  proposal  should  not  fall  directly  on  any  one  group, 
especially  the  employers.  There  must  be  a broad  base  of  revenue  sources. 
These  revenue  sources  may  include  existing  state  and  local  medically 
indigent  funds;  a new  tax  on  cigarettes  and  alcohol;  federal  matching  dollars 
to  pay  for  care  for  those  under  1 00%  of  the  federal  poverty  level;  Medicare 
trust  funds;  and  employer  and  employee  payroll  tax. 

A payroll  tax  should  be  fairly  split  between  an  employer  and  an  em- 
ployee and  should  be  a percentage  of  salary  as  opposed  to  a flat  premium. 
There  should  also  be  a low  income  "floor"  established.  Individuals  earning 
below  this  level  should  be  taxed  at  a lower  rate  or  not  taxed  at  all.  For  all 
other  individuals,  a straight  percentage  of  income  should  be  paid  with  no  cap 
limiting  the  dollar  amount  paid. 

Alcohol  and  Tobacco  Tax 

The  federal  government  must  stop  subsidizing  the  tobacco  industry. 
Colorado  must  place  extra  taxes  on  alcohol  and  tobacco.  These  funds  would 
be  used  to  off-set  the  cost  of  a universal  health  care  plan. 

Health  Individual  Retirement  Accounts  (IRAs) 

The  tax  code  should  be  amended  to  allow  for  penalty-free  and  tax-free 
health  IRAs  and  basic  health  insurance  premiums.  (Also  reference  Cost 
Control  section.) 

Provider  Taxes 

CMS  believes  that  provider  taxes  are  not  an  effective  funding  mechanism 
for  health  system  reform. 

Implementation 

CMS  encourages  an  incremental  implementation  (phase-in)  of  any  health 
system  reform  proposal. 


Administrative  Costs/Hassles 

Administrative  costs  must  be  made  reasonable.  A universal  claim  form 
must  be  implemented.  This  would  include  establishing  uniformity  in  the 
requirements  for  submitting  electronic  claims.  CMS  supports  a move  toward 


364 


Colorado  Medicine  for  October,  1993 


a paperless  system.  A single  procedural  coding  system  must  be  implemented 
by  all  third-party  payers.  Utilization  controls  should  be  uniform  and  periodi- 
cally evaluated  for  demonstrated  effectiveness. 

Purchase  of  optional  supplemental  coverage  from  the  same  insurance 
company  would  be  encouraged. 

Multi-Payer  System 

CMS  does  not  support  the  concept  of  a single  payer  or  the  limitation  in 
the  number  of  payers.  CMS  believes  that  the  individual  is  responsible  for 
selecting  a plan  that  will  meet  his/her  needs.  The  marketplace  should 
determine  the  number  of  payers.  The  role  of  state  government  should  be  to 
insure  the  compliance  with  regulations. 


Quality  assurance,  utilization  review  and  public  health  standards  should 
be  established  with  the  strong  cooperation  and  participation  of  the  medical 
profession.  Physician  care  standards  must  be  determined  by  the  medical 
profession. 

Equally  important  to  monitoring  the  quality  of  medical  care  should  be 
the  monitoring  of  the  performance  of  health  plans. 

Outcome  Research 

The  provision  of  medical  care  should  be  based  on  outcome  research  and 
the  application  of  continuous  quality  improvement  techniques. 

Medical  Ethics 

Physicians  should  continue  to  practice  in  accordance  with  the  highest 
ethical  standards.  CMS  encourages  physicians  to  continue  to  treat  their 
patients  as  individuals  and  to  use  their  best  professional  judgment  in  every 
case. 

Any  meaningful  health  system  reform  plan  will  require  society  to  make 
difficult  choices  regarding  the  complex  and  sensitive  bioethical  issues  we 
face  in  an  era  of  expanding  technology  and  limited  resources.  True  cost 
effective  care  must  be  emphasized.  Physicians  must  retain  their  traditional 
role  as  patient  advocate. 


Appropriate  incentives  need  to  be  built  into  any  health  care  system 
which  encourage  patients  to  make  cost  effective  decisions  about  their  health 
care.  Medisave2  accounts  and  other  health  IRA  arrangements  are  supported, 
other  patient  responsibility  techniques  may  include  copayments,  deductibles 
and  education.  We  do  not  believe  that  inconvenience  or  administrative 
delay  of  the  patient  or  physician  is  appropriate  cost  control. 

Methods  of  cost  control  may  include  the  following: 

Health  Care  Budgets 

The  Colorado  Medical  Society  supports  a budgeting  system  for  health 
care  to  promote  fiscal  responsibility.  However,  CMS  cannot  support  an 
undefined  concept  of  a global  budget. 

A significant  problem  with  applying  budgets  to  the  health  care  system  is 
that  health  care  expenditures  are  not  entirely  predictable  - sickness  and 
disease  are  not  fixed  entities.  Consequently,  determining  an  appropriate 
budget  is  extremely  difficult.  CMS  supports  research  into  health  care  expen- 
ditures to  better  define  where  money  is  spent,  by  whom  and  why. 

CMS  also  believes  that  input  from  the  medical  profession  is  essential  in 
the  development  of  an  adequate  budget  and  that  the  profession  should  be  an 
equal  partner  in  the  budget  development  process.  Antitrust  modifications 
must  be  made  to  allow  for  this  partnership. 

Adherence  to  a health  care  budget  will  by  its  nature  require  the  limita- 
tion of  health  care.  It  is  the  opinion  of  CMS  that  it  is  society's  role  to  make 
choices  regarding  the  implementation  of  this  limitation.  True  cost  effective 
care  must  be  emphasized.  Physicians  must  retain  their  traditional  role  as 
patient  advocate. 


Administration 

(cont.) 


Quality  Control 


Cost  Control 


Cost  Control  (cont.) 


Externalities 


Reimbursement 

CMS  supports  the  establishment  of  a uniform,  statewide,  resource-based 
relative  value  schedule.  The  resource  based  relative  values  for  medical 
services  should  be  developed  by  the  medical  profession.  The  reimbursement 
levels  would  be  negotiated  and  agreed  upon  periodically  by  physicians. 
Physicians'  ability  to  balance  bill  should  continue  to  be  an  accepted  practice 
provided  patients  are  informed  in  advance.  It  is  imperative  that  insurance 
payments  be  made  directly  to  the  provider,  not  the  patient. 

Medical  Versus  "Social"  Costs 

Study  should  be  given  to  a rational  policy  for  long  term  domiciliary  care. 
One  suggestion  is  that  coverage  be  provided  for  the  medical/nursing  compo- 
nent of  domiciliary  care,  whether  delivered  as  home  care  or  as  nursing  home 
care.  The  room  and  board  component,  whether  delivered  as  home  care  or  as 
nursing  home  care,  could  then  be  financed  through  other  social  agencies. 

Healthy  Lifestyles 

Patients/consumers  should  be  provided  incentives  and  disincentives 
based  on  their  lifestyles.  Copayment  amounts  should  vary  according  to 
lifestyles.  For  example,  patients  who  smoke  should  be  required  to  pay  a 
higher  copayment  amount.  Emphasis  must  be  placed  on  the  individual's 
responsibility  for  his  or  her  own  health. 

Appropriate  Levels  of  Care 

Physicians  and  patients  must  continue  to  be  educated  on  the  appropriate 
use  of  medical  care.  In  conjunction  with  this  education,  incentives  need  to 
be  built  into  any  health  care  system  which  encourage  physicians  to  provide 
appropriate  care  and  patients  to  seek  appropriate  care.  Cost-conscious 
decisions  must  be  made  by  both  physicians  and  patients. 

Physician  Education 

Physician  education  is  a cornerstone  of  cost  containment.  There  is  the 
potential  for  significant  cost  savings  by  educating  physicians  on  appropriate 
prescribing  habits  for  pharmaceuticals,  durable  medical  equipment,  choice  of 
procedures  and  like  issues. 

Excess  Capacity 

Addressing  excess  capacity  within  the  health  care  system  is  an  important 
part  of  cost  containment  efforts.  Greater  collaboration  and  cooperation 
among  health  care  providers  should  be  encouraged.  Modification  of  antitrust 
laws  and  regulations  must  be  enacted  to  allow  for  this. 

Advance  Directives 

CMS  believes  that  the  use  of  advance  directives  should  be  expanded.  To 
accomplish  this,  physicians  and  consumers  must  be  provided  with  educa- 
tional opportunities  to  learn  more  about  the  appropriate  use  of  advance 
directives. 

Equipment  and  Pharmaceutical  Costs 

Methods  of  controlling  the  costs  of  durable  medical  equipment,  medical 
supplies  and  pharmaceuticals  must  be  devised. 


Professional  Liability/  Malpractice  Reform 

CMS  strongly  encourages  continued  strengthening  of  Colorado's  tort 
reform  laws  and  other  alternative  dispute  resolution  procedures.  This  might 
include  further  study  of  reduction  of  medical  liability  premiums,  the  elimina- 
tion of  contingency  fees,  the  impact  of  "defensive"  medicine,  and  establish- 
ing an  administrative  versus  tort  system.  We  must  be  aware  that  national  tort 
reform  may  not  improve  what  we  currently  have  in  our  state. 

CMS  supports  national  enactment  o the  Medical  Injury  Compensation 
Reform  Act  of  1975  (MICRA)3 , California's  medical  malpractice  reform  act. 


366 


Colorado  Medicine  for  October,  1993 


Health  Education 

We  must  emphasize  health  education  of  the  public  to  include  the 
hazards  of  substances  known  to  be  harmful  to  public  health.  Also  included 
could  be  K-12  comprehensive  health  curriculum  to  promote  healthy  life- 
styles. CMS  will  continue  to  promote  programs  to  eliminate  smoking, 
discourage  alcohol  and  drug  abuse,  reduce  cholesterol,  encourage  better 
adolescent  health,  and  other  similar  programs  that  are  all  aimed  at  improving 
health  and  reducing  costs  of  health  care. 

Antitrust  Laws  and  Regulations 

Appropriate  peer  review  activities  must  be  protected  from  antitrust 
litigation.  CMS  supports  revision  of  antitrust  laws  and  regulations  to  allow 
the  negotiation  and  review  of  fees.  Other  revisions  should  be  made  to  allow 
cooperation  and  collaboration  among  health  care  providers  to  improve 
quality  and/or  reduce  costs,  e.g.,  to  avoid  duplication  of  services. 


CMS  believes  that  a statewide  dialogue  must  take  place  to  address  the 
challenges  and  critical  issues  regarding  health  system  reform.  The  problem 
facing  the  health  care  system  cannot  be  solved  by  any  one  organization.  A 
collaborative  process  should  be  pursued.  CMS  is  committed  to  the  process  of 
debate  and  discussion.  Colorado  physicians  are  committed  to  delivering 
quality  care  and  want  to  work  with  other  decision-makers  toward  positive 
solutions. 


Externalities  (cont.) 


Conclusion 


EXPLANATORY  NOTES: 

’Point  of  Service 

Point  of  service  plans  combine  managed  care  and  indemnity  features 
into  a single  health  insurance  product.  Subscribers  of  these  plans  typically 
receive  the  highest  level  of  benefits  when  they  use  a primary  care  physician 
to  manage  their  care  and  coordinate  referral  services.  However,  members 
can  also  receive  medical  care  from  any  qualified  medical  care  provider 
without  a referral  if  they  choose.  When  they  choose  this  self-referral  option, 
they  have  a greater  out  of  pocket  expense. 

2MediSave 

MediSave  accounts  would  allow  individuals  to  set  up  health  saving 
accounts  with  tax  free  contributions  from  either  employers  or  individuals,  or 
a combination  of  both.  Individuals  would  then  purchase  health  insurance 
with  a high  deductible,  and  hold  the  balance  of  deposits  in  the  account  to 
pay  for  incidental  medical  expenses.  Any  unspent  funds  would  roll  over  and 
accrue  to  the  individual. 

A central  premise  of  MediSave  is  to  promote  consumers'  decision- 
making role  in  purchasing  health  insurance.  To  the  extent  that  consumers 
shop  for  policies  that  best  serve  their  needs,  a degree  of  competition  and 
cost-consciousness  could  be  restored  to  the  market.  The  strategy  also  could 
provide  consumers  an  economic  incentive  to  look  after  their  general  health 
more  carefully.  Its  roll-over  provisions  would  allow  consumers  to  accumu- 
late savings  in  their  overall  health  care  spending  - savings  achieved  through 
preventive  care  and  health  maintenance. 

3 MICRA 

The  Medical  Injury  Compensation  Reform  Act  (MICRA)  of  1975  is 
considered  the  best  malpractice  reform  package  in  existence  today  and  one 
that  national  and  state  reforms  should  be  modeled  after.  It  consists  of  four 
key  provisions:  1)  a $250,000  limit  on  non-economic  damages,  2)  periodic 
payment  of  future  damages,  3)  a requirement  that  the  jury  hear  evidence  of 
any  "collateral  source"  of  compensation  for  a patient's  injuries,  such  as 
health  or  disability  insurance  payments,  and  4)  a reasonable  sliding  scale 
limit  on  attorney  contingency  fees,  which  ensures  that  a greater  portion  of  the 
award  goes  to  injured  patients  rather  than  to  cover  attorney's  fees. 


Colorado  Medicine  for  October,  1993 


367 


Health 


Care 


Definitions 


The  definition  of  terms  in 
health  care  financing  and 
of  terms  related  to 
delivery , provision  and 
evaluation  of  care. 
Colorado  Medicine 
suggests  you  keep  these 
monthly  articles  and 
definitions , even  though 
many  will  change , some 
will  disappear  and  new 
ones  will  appear  as  the 
health  system  reform 
unfolds. 


TERMS  RELATED  TO 

FINANCING  HEALTH  CARE 

DEDUCTIBLE:  Theamountof  loss 
or  expense  that  must  be  incurred  bythe 
insured  or  otherwise  covered  individual 
before  an  insurer  will  assume  any  li- 
ability for  all  or  part  of  the  remaining 
cost  of  the  services.  Deductibles  may 
be  either  fixed  dollar  amounts  or  the 
value  of  specified  services  (such  as  two 
days  of  hospital  care  or  a physician 
visit).  Deductibles  are  usually  tied  to 
some  reference  period  over  which  they 
must  be  incurred,  e.g.  $100  per  calen- 
dar year,  benefit  period,  or  spell  of 
illness.  Deductibles  in  existing  poli- 
cies are  generally  of  two  types:  (1) 
static  deductibles  which  are  fixed  dol- 
lar amounts,  and  (2)  dynamic  deduct- 
ibles which  are  adjusted  from  time  to 
time  to  reflect  increasing  medical 
prices.  A third  type  of  deductible  is 
proposed  in  some  national  health  in- 
surance plans:  a sliding  scale  deduct- 
ible, in  which  the  deductible  is  related 
to  income  and  increases  as  income 
increases. 

EXPERIENCE  RATING:  A method 
of  establishing  premiums  for  health 
insurance  in  which  the  premium  is 
based  on  the  average  costs  of  actual  or 
anticipated  health  care  used  by  vari- 
ous groups  and  subgroups  of  subscrib- 
ers and  thus  varies  with  the  health 
experience  of  groups  and  subgroups  or 
with  such  variables  as  age,  sex,  or 
health  status.  It  is  the  most  common 
method  of  establishing  premiums  for 
insurance  in  private  programs. 

INSURANCE  BENEFITS:  A sum  of 

money  provided  in  an  insurance  policy 
payable  for  certain  types  of  loss,  or  for 


covered  services,  under  the  terms  of 
the  pol  icy.  The  benefits  may  be  paid  to 
the  insured  or  on  his  behalf  to  others. 
In  prepayment  programs,  like  HMOs, 
benefits  are  the  services  the  program 
will  provide  a member  whenever,  and 
to  the  extent  needed.  The  indemnity 
insurance  contract  usually  defines  the 
maximum  amounts  which  will  be  paid 
for  the  covered  services.  In  most  cases, 
after  the  provider  of  service  has  billed 
the  patient  in  the  usual  way,  the  in- 
sured person  submits  to  the  insurance 
company  proof  that  he  has  paid  the 
bills  and  is  then  reimbursed  by  the 
company  in  the  amount  of  the  covered 
costs,  making  up  the  difference  him- 
self. In  some  instance,  the  provider  of 
service  may  complete  the  necessary 
forms  and  submit  them  to  the  insur- 
ance company  directly  for  reimburse- 
ment, billing  the  patient  for  costs  which 
are  not  covered.  Indemnity  benefits 
are  contrasted  with  service  benefits. 
Service  benefits  are  those  received  as  a 
result  of  prepayment  or  insurance, 
whereby  payment  is  made  directly  to 
the  provider  of  services  or  the  hospital 
or  other  medical  care  programs  for 
covered  services  provided  by  them  to 
eligible  persons.  Service  benefits  may 
be  full  service  benefits,  meaning  that 
the  plan  fully  reimburses  the  hospital, 
for  example,  for  all  services  provided 
during  a period  so  that  the  patient  has 
no  out-of-pocket  expenses.  Full  ser- 
vices benefits  may  also  be  available 
when  the  program  itself  provides  the 
service  as  in  a prepaid  group  practice. 
Partial  service  benefits  cover  only  part 
of  the  expenses,  the  remainder  to  be 
paid  by  the  beneficiary  through  some 
form  of  cost-sharing. 


368 


Colorado  Medicine  for  October,  1993 


1 994  Copic  rates  announced 

Rates  up,  prices  down  (and  much  more ) 


HIGHLIGHTS 

1 . Copic  announces  first  across- 
the-board  rate  increase  since 
1988. 

2.  Experience  Rating  System 
(ERS)  replaces  long-standing 
Preferred  Risk  Premium 
Program  (PRPP)  -and  all 
insureds  are  eligible  in  1 994. 

3.  1994  Policyholder  Distribu- 
tion of  20%  reduces  insurance 
costs  below  those  of  1 993. 

4.  Ongoing  loss-cost  analysis 
produces  rate  increases  for  a 
few  specialty  groups,  decreases 
for  others  . 


1 . Rates  increase  by  9%  - As  we 

have  done  since  inception  in  1 982, 
Copic  establishes  rates  each  year  by 
consulting  with  two  independent 
actuaries.  Those  two  firms  produce 
for  us  an  estimation  of  the  premium 
needed  for  the  coming  year  to  cover 
indemnity  and  defense  costs;  those 
predicted  costs  are  then  spread 
across  the  spectrum  of  insured 
physicians  in  accordance  with  the 
losses  incurred,  on  a specialty-by- 
specialty basis.  Table  1 demonstrates 
the  historical  relationship,  on  a 
company-wide  basis,  of  pricing  vs. 
losses  over  the  past  several  years. 
While  it  is  readily  apparent  that  our 
actuaries  were  wrong  in  the  late 
1980s,  predicting  losses  substantially 
in  excess  of  what  eventually  devel- 
oped, it  is  equally  as  apparent  that 
Colorado,  like  the  rest  of  the  U.S.,  is 
experiencing  a slow  but  steady 
increase  in  the  overall  costs  in 
medical  liability  claims.  Our 
favorable,  downward  trend  in  prices 


resulted  from  a decline  in  the 
frequency  of  claims,  while  the 
severity  (total  cost)  continues  inexo- 
rably upward. 

The  bad  news  is  the  base  rate  is 
increasing  for  all  insureds  in  1994  - 
but  for  at  least  one  year  the  bad 
news  is  offset  by  the  favorable 
pricing  effect  of  both  the  Experience 
Rating  System  (ERS)  and  a policy- 
holder distribution  in  1994  of 
$9,000,000.  (see  ERS  Points  Sched.) 

2.  Experience  Rating  System  - Since 
1984  those  physicians  in  the  top 
25%  of  their  specialty  were  eligible 
for  the  Preferred  Risk  Premium  Plan 
(PRPP),  based  upon  length  of  time 
with  the  company,  their  attendance 
at  Risk  Management  Seminars,  and 
the  absence  of  "negative  EN  points" 
acquired  through  violating  Risk 
Management  Guidelines.  Some  of 
the  impetus  for  compliance  with  this 


program  was  lost  when  physicians 
realized  that  they  needed  both  to 
attend  seminars  and  gain  points 
simply  through  longevity.  Many  of 
you  have  asked  that  a more  equi- 
table system  be  considered. 

Commencing  on  1 January  1994, 
PRPP  is  discontinued  and  replaced 
by  a new  ERS  - Experience  Rating 
System  - with  all  insureds  initially 
eligible  and  enrolled  in  the  Preferred 
rate  group,  and  with  continuing 
eligibility  determined  both  by 
attendance  at  Risk  Management 
Seminars  ("positive  points")  and  by 
point  debits  associated  with  violation 
of  Risk  Management  Guidelines  and/ 
or  specific  dollar  losses.  (Member- 
ship in  the  Preferred  Rate  Group 
provides  you  a discount  on  premium 
charges  of  1 0%  at  the  $ 1 00,000/ 
300,000  level  - an  approximate  5% 
savings  at  the  $1,000,000/3,000,000 
policy  limit). 


Colorado  Medicine  for  October,  1993 


369 


ERS  Points  Schedule 

Positive  Points 

Negative  Points 

+2  Specialty  Seminar 

-1  to -3  Guidelines  violations 

+2  General  Seminar 

-1  Indemnity  losses  $50,000  - $ 1 00,000 

(once  each  6 yrs) 

+ 1 Office  employee  seminar 

-2  Indemnity  losses  SI  00,000  -$500,000 

+1  Miles  Communication  Workshop 
+1  Other  pre-approved  meetings 

-3  Indemnity  losses  over  $500,000 

Within  any  two-year  period  an 
insured  physician  may  earn  a 
maximum  of  four  (4)  points  through 
meeting  attendance,  and  may 
potentially  lose  up  to  six  (6)  points 
on  the  basis  of  losses  or  guidelines 
violations  appealed  to  the  company, 
and  it  is  anticipated  that  some  of  the 
dollar-loss-only  appeals  will  be 
sustained  (runaway  jury  verdicts  still 
do  occur,  despite  our  estimation  that 
the  doctor  practiced  perfect  medi- 
cine and  our  vigorous  defense  of  a 
lawsuit).  Continued  eligibility  for 
Preferred  Rate  status  under  ERS  will 
be  achieved  by  maintaining  a 
cumulative  point  total  equal  to,  or 
greater  than,  75%  of  the  possible 
points  achievable  through  meetings 
attendance  - and  avoiding  the 
negative  point  debits  associated  with 
violations  of  Guidelines  and/or  the 
dollar  losses  as  specified.  This  new 
system  (ERS)  attempts  to  answer  the 
two  main  challenges  to  PRPP:  That 
an  insured  had  to  be  here  a long 
time  to  be  eligible  for  Preferred 
Rates;  and  that  those  with  no  paid 
losses  were  paying  the  same  price  as 
those  who  caused  losses  to  be  paid. 


3.  1994  Policyholder  Distribution  - 
$9,000,000  - 20%  savings  on 
insurance  cost. 

Reference  again  to  Table  1 will 
indicate  that  the  "gap"  between 
pricing  and  losses  actually  represents 
premium  dollars  collected  from  you 
which  were  not  needed  to  pay  losses 
- surplus  surplus,  if  you  prefer. 

Copic  has  guaranteed  you  that  as 
such  favorable  developments  are 
realized  those  dollars  will  be  re- 
turned to  each  policyholder  on  a 
contemporary  basis.  Returns  realized 
by  Copic  insureds  during  the  period 
1990  to  1994  are  displayed  in  Table 
2 

Table  2 


Policyholder  Distributions 


1990  $2,500,000 

1991  $3,500,000 

1992  $6,162,000 

1993  $6,000,000 

1994  $9,000,000 

Total  $27,155,000 


Since  we  anticipate  that  total 
premium  volume  for  1 994  will 
approximate  $45  million,  it  is 
apparent  that  the  Policyholder 
Distribution  in  that  year  -to  be 
credited  equally  on  all  four  quarterly 
statements  - will  further  reduce  your 
actual  costs  for  insurance,  to  a level 
lower  than  you  paid  in  1 993.  We 
must  emphasize,  however,  that  your 
costs  are  lower  at  the  same  time  as 
rates  are  increased  - so  that  the  full 
reality  of  a 1994  rate  increase  may 
first  be  apparent  to  you  as  you 


370 


Colorado  Medicine  for  October,  1993 


renew  your  policy  in  1995.  (A  little 

financial  long  range  planning  may  be 
in  order.) 

4.  Some  specialties  up,  others  down, 
based  on  continuing  evaluation  of 
losses.  The  most  consistent  overall 
trend  noted  by  the  44  physician- 
owned  liability  insurers  during  the 
past  several  years  has  been  previ- 
ously reported  to  you:  Physician 
losses  are  creeping  up  (failure  to 
diagnose  cancer  or  infection, 
complications  from  medications), 
while  Surgeon  losses  trend  steadily 
downward  (informed  consent  issues, 
communication  and  technical 
improvements).  Trends  in  Copic  are 
in  most  instances  following  those 
seen  nationally,  and  include  the 
following: 


in  your  behalf  with  the  myriad  of 
folks  addressing  all  aspects  of 
"Health  Care  Reform";  are  working 
with  executive  and  legislative 
branches  of  state  government  on 
reform  and  other  issues;  have 
assisted  the  BME  (Board  of  Medical 
Examiners)  over  some  Amendment 
One  hurdles;  and  are  positioning 
Copic  to  be  able  to  provide  all 
necessary  coverage  for  whatever 
entities  emerge  from  the  ongoing 
evolution  of  our  health  care  delivery 
system. 

Your  company  is  strong,  not  only 
financially  but  in  its  outstanding 
professional  staff,  and  is  working  full 
time  to  attempt  to  create  the  best 
possible  milieu  for  practice  in 
Colorado,  and  to  lessen  the  burdens 
imposed  by  change  — not  always,  as 
designed  by  the  bureaucrats,  change 


Rate  Trends  by  Specialty  Practice 

Specialty  Rate  Increases 

Occupational  Medicine 
Internal  Medicine  & Specialties 
(except  Invasive  Cardiology) 
Psychiatry 
Neurology 
Otolaryngology 
Plastic  Surgery 


Specialty  Rate  Decreases 

Surgeon,  Office  Practice  Only 
Emergency  Medicine 
Colorectal  Surgery 
Gynecology 
FP/GP  Obstetrics 
Orthopaedic  Surgery 
Obstetrics/Gynecology 
Neurosurgery 


(Please  contact  your  Policyholder  Service  representative  for  further  details.) 


In  summary,  1994  will  be  a year 
of  multiple  changes  at  Copic  and  for 
our  nearly  4,000  insured  physicians  - 
some  bad  news  about  rate  increases, 
more  good  news  concerning  both 
the  Experience  Rating  System  and 
upcoming  Policyholder  Distribution 
of  $9,000,000.  In  addition,  many 
parts  of  your  company  are  involved 


for  the  better. 

We  welcome  your  comments, 
your  criticisms,  your  suggestions  -- 
each  person  at  Copic,  from  the 
Chairman  to  the  clerical  staff, 
answers  his/her  own  phone,  and  we 
are  here  to  provide  whatever  service 
we  can,  in  the  most  expeditious 
fashion. 


Copic  has  modified  its 
standard  policy  language 
to  clarify  that  we  do  not 
provide  defense  or  liabil- 
ity coverage  when  you  are 
the  subject  of  any  peer 
review  activity  or  if  you  or 
your  office  violates  any 
civil  rights  statutes , in- 
cluding the  Americans 
With  Disabilities  Act. 


r n/nraWn  A Aortirint*  tnr  Drtnhpr 


i qq^ 


371 


CMS  Education  and  Research 
Foundation 


Facts 

The  Colorado  Medical  Society 
Foundation  for  Education  and 
Research  (CMS  ERF)  is  a non  profit 
tax  exempt  charitable  foundation 
which  was  established  in  1 982 
primarily  for  the  purposes  of  con- 
ducting scientific  educational  and 
charitable  programs.  This  Founda- 
tion is  funded  primarily  by  contribu- 
tions from  CMS  members.  In 
addition,  the  Colorado  Medical 
Society  remembers  each  deceased 
Society  member  by  a contribution  of 
$25. 

CMS/ERF 


AMA-ERF  and  CMS-ERF  at  a Glance 


AMA-ERF 

CMS-ERF 

-Tax  deductible  contribution 

-Funds  support  medical  schools  (researach 

v/ 

projects,  computer  software,  guest  lecturers, 
programs  for  student  groups,  etc.) 

%/ 

-Funds  support  medical  students  (loans, 
grants,  scholarships) 

-Funds  support  CMS  Medical  Student 
Component  Society  projects 
-Funds  support  experimental  or  pilot 
health  and  medical  programs 
-Funds  support  organizations  other 

v/ 

y 

y 

v/ 

y 

than  medical  schools  (Colorado  State 
Science  Fair,  CMS  Education  Program, 
etc.) 

y 

-Funds  remain  in  Colorado 

-Funds  may  be  designated  to  out-of-state 

v/ 

y 

medical  schools 

-Billed  directly  by  AMA  Alliance 
-Billed  directly  by  CMS 

%/ 

y 

W.  Gerald  Rainer ; M.D. 
Chairman 

For  the  Board  of  Directors, 


Although  the  funds  from  this 
Foundation  have  been  used  in  the 
past  for  loan  funds  to  medical 
students,  more  recently  the  Board 
has  voted  to  devote  its  interest 
primarily  to  the  funding  of  two  half- 
tuition scholarships  amounting  to 
$5000  each  to  financially  disadvan- 
taged medical  students  with  appro- 
priate academic  credentials  and  who 
are  willing  to  practice  in  the  state  of 
Colorado.  Leigh  Truitt,  M.D. , the 
Immediate  Past  President  of  CMS, 
has  stated  that  he  will  solicit  match- 
ing funds  from  other  foundations  and 
organizations. 

As  of  July  of  this  year,  the 
Foundation's  fiscal  balance  is 
something  over  $54,000.  Seven 
students  have  qualified  for  low 
interest  loans  totaling  $1 1 ,000  and 
as  of  October,  1 992,  $9,1 00  of  this 
had  been  repaid. 

In  addition,  the  CMS/ERF 
supports  the  Colorado  State  Science 
Fair  and  the  Educational  Program  of 
the  CMS  Annual  Meeting. 

The  Board  of  Trustees  consists  of 
seven  members.  The  Treasurer  of 
CMS  serves  as  the  Treasurer  of  the 
Foundation  and  members  of  the 
Board  are  elected  by  the  CMS  Board 
of  Directors.  At  least  four  members 
of  the  Foundation  Board  must  be 
members  of  the  Colorado  Medical 
Society. 

The  Education  and  Research 
Foundation  continues  to  solicit  the 
support  of  its  members  so  that  it  can 
continue  to  prosper  and  to  carry  out 
the  educational  programs  as  outlined 
above. 


372 


Colorado  Medicine  for  October,  1 993 


AMA  Education  and  Research 

Foundation 


AMA-ERF  was  started  as  Ameri- 
can Medical  Education  Fund  by  the 
Board  of  Trustees  of  the  AMA  in 
1 950  to  support  quality  education  in 
the  nation's  medical  schools.  The 
monies  were  given  to  medical 
schools  to  help  minimize  the  need 
for  federal  assistance  to  medical 
education.  Originally,  the  AMA  gave 
$500,000  per  year,  but  in  1 955,  the 
AMA  Auxiliary  was  called  upon  to 
make  AMEF  fund  raising  a major 
effort.  Since  that  time,  the  annual 
average  gifts  have  been  over  $1 
million,  and  for  the  last  four  years, 
have  exceeded  $2  million  per  year. 

In  1957,  the  AMRF  (American 
Medical  Research  Foundation)  was 
founded  to  encourage  gifts  to 
medical  research.  The  two  entities 
were  merged  in  1962,  as  AMA-ERF. 

Today,  AMA-ERF  contributions 
support  four  main  funds: 

The  MEDICAL  SCHOOL  EXCEL- 
LENCE FUND  provides  unrestricted 
grants  to  medical  schools  for  use  in 
subsidizing  research  projects,  guest 
lecturers,  attendance  at  conferences, 
computer  software,  or  support 
programs  for  student  groups. 

The  DEVELOPMENT  FUND  may 
be  used  to  support  experimental  or 
pilot  health  and  medical  programs. 
This  fund  sponsors  the  National 
Student  Research  Forum,  and  three 
Regional  Forums. 

The  CATEGORICAL  RESEARCH 
GRANT  FUND  comes  from  donors 
who  request  that  their  contributions 
support  research  in  a specific  field  of 
medicine.  Request  for  grants  from 
this  fund  are  considered  by  the 
AMA-ERF  Board  of  Directors. 

Contributions  not  designated  for 
a particular  medical  school  or  fund 
are  put  into  the  Development  Fund. 


Medical  School  Excellence  Fund  gifts 
not  designated  for  a certain  school 
are  divided  equally  among  all  the 
medical  schools;  if  a state  is  speci- 
fied, all  medical  schools  in  that  state 
will  benefit  equally.  Donors  may 
also  request  that  donations  over 
$1 00  be  given  special  handling  and 
specified  for  a project. 

Since  its  inception,  AMA-ERF 
has  distributed  over  $57  million  in 
gifts  to  medical  schools  (including 
over  $48  million  to  the  MEDICAL 
SCHOOL  EXCELLENCE  FUND,  and 
$6  million  to  the  MEDICAL  STU- 


DENT ASSISTANCE  FUND)  Be- 
tween 1 962  and  1 980,  over  $95 
million  in  loans  had  been  guaranteed 
for  medical  students,  interns  and 
residents. 

The  consistent  generosity  of  the 
medical  family  to  medical  education 
is  tangible  proof  of  the  dedication  of 
the  practicing  profession  to  continu- 
ing excellence  in  medical  education 
and  to  improving  health  care  for  the 
future.  Continued  fund  raising  efforts 
and  generosity  will  secure  AMA- 
ERF's  effectiveness  and  assure  its 
future  success. 


Medical  Student  Component 


Frenchy 

by  Shaun  Thompson,  MSIII 

(Ed.  note:  This  story  is  Mr.  Thompson's  winning  entry  in  the  Medical  Student  Creative  Writing  contest  sponsored  by 
the  CMS  Board  of  Directors  and  the  Medical  Student  Component  Society  last  spring.) 


" Her  flowery  dresses  and 
Nike  airs  embodied  her 
fresh  and  airy  attitude. " 


As  Floyd  rushed  into  my  office,  I 
could  see  in  his  eyes  that  he  had 
some  bad  news  to  share  with  me. 
Actually,  I couldn't  see  into  his  eyes 
because  he  has  poor  vision  and  his 
telescopic  eyeglasses  acted  like  small 
one-way  mirrors.  Nonetheless,  I 
sensed  that  he  was  about  the  relate 
something  sorrowful  to  me.  It  turns 
out  that  he  had  been  informed  that 
our  mutual  friend  "Frenchy"  had 
passed  away. 

For  the  past  nine  and  a half 
years,  I have  been  the  director  of  the 
"F-lelping  Hands  Mission".  This  is  an 
organization  funded  and  supported 
by  several  local  churches  which  has 
as  its  goal  the  feeding  of  and  caring 
for  the  homeless  and  the  indigent. 
These  people  are  all  special  in  their 
own  way  and  have  filled  my  life  with 
headaches,  heartaches,  and  side 
aches.  Though  I love  them  all,  I 
consider  them  misfits,  and  myself  the 
queen  of  the  misfits.  From  six  foot 
two  Scott  who  could  never  make 
through  the  six  foot  zero  door  frame 
without  hitting  his  head  and  finally 
had  to  put  a note  above  it  that  read 
"How  many  times  you  got  to  hit  your 
head  Dumby?",  to  dear  old  Mr. 
Bennett  who  falls  and  skins  his  nose 
each  November  while  stocking  his 
home  with  enough  cigarettes  to  last 
five  men  through  the  winter.  These 
are  the  people  I spend  my  day  with. 

Frenchy  was  one  of  our  long 
time  volunteers  who  would  help  out 
one  day  each  week  by  folding 


clothes  that  had  been  donated  and 
distributing  food  to  our  clients. 
Though  she  was  well  into  her 
eighties  and  not  much  better  off  than 
the  people  she  served,  she  was  a 
terrific  worker  and  never  grumbled 
or  let  the  despair  around  her  dimin- 
ish her  happy  and  strong  spirit.  Her 
flowery  dresses  and  Nike  airs 
embodied  her  fresh  and  airy  attitude 
that  made  you  feel  like  Springtime 
itself  was  following  just  behind  her. 

I arose  early  the  next  morning 
and  turned  on  the  local  radio  station 
as  was  my  custom.  I caught  the 
closing  of  the  obituary  listings  and 
heard  the  name  "Frenchy"  out  of  the 
corner  of  my  ear.  ! noted  the  time 
and  place  of  the  funeral  service  so 
that  I might  attend  and  show  my 
respect. 

As  I arrived  at  the  Catholic 
church,  I signed  the  guest  book  and 
allowed  the  usher  to  show  me  to  a 
seat  near  the  rear  of  the  crowded 
sanctuary.  I thought  it  odd  that  I was 
not  provided  with  a bulletin  listing 
information  about  the  deceased  and 
who  the  pall  bearers  were,  but  I just 
assumed  that  they  had  not  printed 
enough.  It  also  struck  me,  as  the 
service  proceeded,  that  the  celebrant 
had  not  mentioned  the  name  of  our 
departed  friend.  He  recounted 
accomplishments,  related  stories, 
and  prayed  for  our  late  companion 
but  never  once  uttered  a name.  I 
figured  that  this  was  a defense 
mechanism  decreed  by  the  Pope  that 


374 


Colorado  Medicine  for  October,  1993 


"Frenchy" 


all  Catholics  had  to  follow,  and  said 
the  name  Frenchy  in  my  head 
whenever  I thought  it  was  appropri- 
ate. 

At  the  conclusion  of  the  service, 
the  casket  was  opened  for  the 
viewing  of  the  body.  As  I waited  my 
turn  to  say  good-bye  to  my  friend,  I 
tried  to  picture  her  in  my  mind  as 
she  was  the  last  time  I saw  her: 
vivacious,  sparkling,  and  beautiful. 
Upon  reaching  the  casket  and 
peering  in,  I was  so  shocked  that  I 
fumbled  my  way  backwards  and 
attempted  to  squelch  a yelp.  I think  it 
was  the  red  and  white  baseball  cap 
perched  on  the  balding  head  in  stark 
contrast  to  the  billowy  blue  satin 
pillow  upon  which  it  was  resting  that 
initially  caused  my  heart  arrhythmia. 
The  body  I had  seen  was  not  that  of 
my  dear  friend  at  all,  but  of  some  of 
whom  I had  never  seen  before. 

While  attempting  to  feign  calmness 
and  grief,  I made  my  way  back  to  the 
main  part  of  the  church  to  do  a little 
detective  work.  I found  the  Monsi- 
gnor and  told  him  what  a nice  liturgy 
it  was  and  how  I had  felt  comforted 


by  his  words.  He  replied  by  saying 
how  thoughtful  it  was  of  me  to 
attend  and  that  Frenchy  would  have 
appreciated  it.  "Frenchy?"  I said, 
thinking  that  I would  be  revealed  as 
the  fraud  I was.  Just  then  some  family 
members  approached  and  one  of 
them  introduced  himself  as  the  son 
of  the  deceased.  His  last  name  was 
Frenzl. 

The  next  Wednesday,  as  I was 
working  in  my  office,  I became 
aware  of  a shape  at  the  door.  I was 
startled  to  look  up  and  see  my 
beloved  friend  Frenchy  Fontaine. 
Overjoyed,  I hugged  her  and  took 
her  to  the  back  room  to  see  the  other 
volunteers.  As  a group,  they  were 
quite  surprised  and  delighted  to  see 
her.  She  was  showered  with  over- 
whelming affection,  and  after  all  the 
hugging,  we  recounted  to  her  what 
Floyd  had  told  us  just  a few  days 
before.  It  is  amazing  what  kind  of 
positive  effect  a resurrection  can 
have  on  a group  of  people.  I did  not 
relate  my  misadventure,  but  gave 
Frenchy  an  extra  warm  embrace  and 
told  her  how  much  I appreciated  her. 


"It  is  amazing  what  kind 
of  positive  effect  a 
resurrection  can  have  on  a 
group  of  people." 


MSC  View  of  Annual  Meeting 


The  Medical  School  Compo- 
nent was  well-represented  at  this 
year's  annual  meeting  in  Snow- 
mass.  Fifteen  students  attended 
the  meeting,  including  three 
delegates. 

The  students  put  forward  a 
resolution.  Drafted  by  Nick 
Slenkovich  and  Carolyn  Wep- 
man,  it  focused  on  gun  control 
and  its  social  and  health  impacts. 
The  resolution  passed  the  House 


by  one  vote. 

Within  the  past  year,  the 
number  of  voting  delegates  in  the 
House  from  the  MSC  increased 
from  one  to  three.  As  of  Septem- 
ber 15,  1993,  because  the  MSC 
membership  has  surpassed  100, 
five  delegates  will  be  elected  to 
represent  the  MSC  at  the  Interim 
meeting  next  March. 

The  mentor  program  contin- 
ued to  draw  a good  response  at 


the  annual  meeting.  Over  80 
physicians  are  now  in  the 
program  with  roughly  the  same 
number  of  students.  More 
physicians,  from  all  specialties 
and  locations  throughout  the 
state,  are  invited  to  participate. 
For  more  information,  call 
Theresa  Scholz  at  (303)  321  - 
8860. 


375 


CnlnraHn  MpHirinp  fnr  Ortnhpr  1993 


The  Colorado  Medical  Society  and  the  Medical  Student  Component  would  like 
to  welcome  the  University  of  Colorado  Medical  School  Class  of  1997 : 


NAME 

HOMETOWN 

Jason  Hollensbe 
Ray  Howe 

Bailey 

Evergreen 

Bruce  Adams 

Denver 

David  Hutcheson-Tipton 
Michael  Jankoviak 

Aurora 
La  Porte,  IN 

Kevin  Adams 

Evergreen 

Luz  Maria  Jimenez 

Denver 

Andrea  Alexander 

Fairfield,  CT 

Courtney  Johnson 

Denver 

Holly  Amsbury 

Boulder 

Daniel  Johnson 

Denver 

Katherine  Anderson 

Denver 

Elizabeth  Johnson 

St.  Paul,  MN 

Laura  Anderson 

Littleton 

Steven  Johnson 

Denver 

Claudia  Anison 

Los  Alamitos,  CA 

Tory  Katz 

Englewood 

Jacquelyn  Aschenbrenner 

Thomas  Kenigsberg 

Kenver 

Philip  Baese 

Colorado  Springs 

John  Koeppe 

Sonya  Becker 

Littleton 

Michelle  Kuntz 

Otis 

Martin  Bell 

Grand  Junction 

Astrid  Lampey 

Estes  Park 

Jason  Bennett 

Denver 

Thomas  Lawrey 

Ft.  Collins 

John  Berneike 

Boulder 

Joseph  Lee 

Denver 

David  Biddle 

Golden 

Richard  Lee 

Colorado  Springs 

Peter  Blackburn 

Parker 

Vivian  Lombillo 

Boulder 

Abby  Bleistein 

Denver 

David  Lopresti 

Colorado  Springs 

Kathleen  Braddy 

Littleton 

Cari  Loss 

Englewood 

Ingnatius  Brady 

Northbrook,  IL 

Gary  Maerz 

Pueblo 

Todd  Brinker 

Evergreen 

Sarah  Magoun 

Boulder 

Elizabeth  Brost 

Colorado  Springs 

Frances  Maguire 

Stephanie  Calkins 

Saratoga,  WY 

Sean  Markey 

Boulder 

Karin  Cesario 

Englewood 

Gregory  Martin 

Colorado  Springs 

David  Chavez 

Loveland 

Monique  McCray 

Denver 

Josh  Cochrane 

Ft.  Collins 

A.  Victoria  McKane 

Boulder 

Randolph  Cordova 

Walsenburg 

Jon  Miller 

Whitefish,  MT 

Brian  Cruz 

Ft.  Collins 

Kimberly  Miller 

Michelle  Deden 

Denver 

Patrick  Miller 

Denver 

Jeannae  Dergance 

Littleton 

Andrew  Mohler 

Grand  junction 

James  Derrisaw 

Cheyenne,  WY 

Annette  Riggs 

Rancho  Santa  Fe,  CA 

Marc  Doucette 

Denver 

Sara  Rohrback 

Cody,  WY 

Julia  Draznin 

Denver 

Shane  Rose 

Durango 

Frank  Dumont 

Loveland 

Kristen  Rundell 

Denver 

Andreas  Edrich 
Bruce  Evans 

Ann  Arbor,  Ml 

Kathryn  Rutledge 
Laurel  Saliman 

Ft.  Collins 

Joy  Ezidinma 

Denver 

John  Sandoval 

Pueblo 

Phaedra  Fegley 

Ft.  Collins 

Stephen  Sawyer 

Golden 

Sherry  Ferrell 

Westminister 

Benjamin  Schneider 

Pueblo 

Lizbeth  Field 

Berkley,  CA 

Kenneth  Serra 

Sunnyvale,  CA 

Rosario  Floridia 

Marin  Co.,  CA 

Sam  Shimamoto 

Billings,  MT 

Yuk  Ling  Foo 

Denver 

Sarah  Starr 

Boulder 

Daniel  Fosburgh 

Aurora 

Joseph  Tasto 

Boulder 

Peter  Free 

Boulder 

Duane  Thomas 

Great  Falls,  MT 

Peter  Fuhr 

Boulder 

Michael  Thompson 

Woodland  Park 

David  Garrison 

Grand  Lake 

Kimberly  Trampedecker 

Denver 

Robert  Garrison 

Ft.  Collins 

Xuantrang  Truong 

Denver 

Amy  Ghaibeh 

Lamar 

Sarah  Vanhandel 

Colorado  Springs 

Robert  Gramling 

Holden,  MA 

Stephen  Vinge 

Arvada 

Eric  Hammerberg 

Denver 

Kathleen  Walker 

Englewood 

Douglas  Hammond 

Aurora 

Juliann  Wallner 

Littleton 

Shawna  Harris 

Colorado  Springs 

Kathleen  Watt 

Englewood 

Glenn  Herrmann 

Boulder 

Randall  Williams 

Boulder 

We  invite  each  of  you  to  join  the  Colorado  Medical  Society  through  the  Medical  Student  Component. 


Colorado  Medicine  for  October,  1 993 


376 


OSHA  Training  Requirements 


from  Lynn  Livingston 
Health  Care  Policy  Department 


Last  year  physicians  were 
required  to  comply  with  OSHA's 
Bloodborne  Pathogen  Standard.  The 
Standard  stated  that  employers  must 
provide  training  to  employees  with 
occupational  exposure  by  June  4, 
1992  and  at  least  annually  thereafter. 

Following  is  a review  of  what 
needs  to  be  included  in  the  annual 
training. 

• A review  of  the  basics  covered  in  the 
original  training  last  year 

• An  explanation  of  how  an  employee 
can  obtain  a copy  of  the  OSHA  stan- 
dard and  an  explanation  of  its  con- 
tents 

• A general,  understandable  review  of 
the  epidemiology  and  symptoms  of 
bloodborne  diseases 

• An  explanation  of  modes  of  trans- 
mission of  bloodborne  pathogens 

• An  explanation  of  the  exposure  con- 
trol plan  and  the  means  by  which  an 
employee  can  obtain  a copy 

• An  explanation  of  the  methods  of 
recognizing  tasks  and  activities  that 
may  involve  exposure  to  blood  and 
other  potentially  infectious  materi- 
als 

• An  explanation  ofthe  use  and  limita- 
tions of  engineering  controls,  work 
practices  and  personal  protective 
equipment 

• Types,  proper  use,  location,  removal, 
handling,  decontamination  and  dis- 
posal of  personal  protective  equip- 
ment 

• An  explanation  ofthe  basis  for  selec- 
tion of  personal  protective  equip- 
ment 

• Information  on  the  hepatitis  B vac- 
cine, including  information  on  its 
efficacy,  safety,  method  of  adminis- 
tration, the  benefits  of  being  vacci- 
nated and  that  the  vaccine  and  vac- 
cination wi  1 1 be  offered  free  of  charge 


• Information  on  the  appropriate  ac- 
tions to  take  and  persons  to  contact 
in  an  emergency  involving  blood  or 
other  potentially  infectious  materi- 
als 

• Procedures  to  follow  if  an  exposure 
incident  occurs,  including  the 
method  of  reporting  the  incident  and 
the  medical  follow-up  that  will  be 
made  available 

• Informationon  post-exposure  evalu- 
ation and  follow-up  procedures  that 
the  employer  is  required  to  provide 
for  the  employee  following  an  expo- 
sure incident 

• An  explanation  of  signs  and  labels 


and/or  color  coding  required  by 
OSHA 

• An  opportunity  for  interactive  ques- 
tions and  answers  with  the  person 
conducting  the  training  session 

Records  of  annual  trainings  must 
be  maintained  for  a period  of  three 
years.  These  records  must  include 
the  following: 

1.  Dates  the  training  took  place 
4.  Summary  of  the  contents  of  the 
training 

3.  Names  and  qualifications  of  the 
trainers 

4.  Names  and  job  titles  of  those  in 
attendance 


Your  next  job 
is  on  the  line. 

1*800*233*9330 

Finally  you  have  direct  access  to  career  opportunities  across  the 
country.  The  new  Practice  Opportunity  Line  offers  an  easy, 
no  pressure,  confidential  way  to  conduct  a thorough  job  search 
on  your  own,  24  hours  a day.  All  you  have  to  do  is  call,  follow 
the  prompts  and  research  the  openings.  Then  send  a voice  mail 
mini-CV  to  tire  opportunities  you  wish  to  pursue.  It’s  the  newest, 
fastest  and  simplest  way  to  get  the  job  you  want. 

The  Practice 
Opportunity  Line 

Were  on  call  for  you. 
fmm  Physician's  Market  Information  Center  1*800*423*1229 


Colorado  Medicine  for  October.  1993 


377 


New  law  affects  deductibility  of  dues 


The  1993  Revenue  Reconciliation 
Act  changes  the  way  the  IRS  will 
view  the  deductibility  of  your  dues  to 
organizations,  including  the  Colo- 
rado Medical  Society. 

CMS  estimates  that  6%  of  your 
dues  money  goes  toward  lobbying 
expenses.  This  portion  is  no  longer 
deductible,  even  as  a business 
expense.  (In  addition,  you  are 
reminded  that  the  present  law 
already  disallows  deduction  for 
expenses  incurred  by  grass  roots 
lobbying  and  participation  in 
political  campaigns.) 

The  IRS  will  consider  all  our 
lobbying  efforts  as  being  paid  for  out 
of  your  dues.  The  Act  also  repeals 


the  deduction  for  lobbying  expenses. 
That  means  that  the  portion  of  your 
dues  which  pays  for  lobbying 
activities  is  not  longer  deductible 
from  your  income  tax. 

Message  from  the  federal 
government:  If  you  are  going  to 
make  an  impact  on  the  political 
process  you  must  do  it  at  your  own 
expense.  It  is  not  deductible  from 
your  income  tax.  Because  the  CMS 
acts  on  your  behalf,  using  your 
money,  to  influence  the  political 
process,  that  portion  of  your  dues  is 
also  not  deductible. 

The  wording  to  the  right  will 
appear  on  your  1 994  dues  statement: 


Contributions,  including 
COMPAC/AMPAC,  ore  not 
deductible  as  charitable 
contributions  for  federal 
income  tax  purposes.  How- 
ever, dues  payments  may  be 
deductible  by  members  as  an 
ordinary  and  necessary 
business  expense.  Recent 
federal  legislation  prohibits 
you  from  deducting  any 
portion  of  your  membership 
dues  that  directly  supports  our 
lobbying  efforts.  6%  of  your 
1 994 CMS  membership  dues 
are  NOT  tax  deductible. 


FLIGHT  SURGEONS 
WANTED. 

Discover  the  thrill  of  flying,  the  end  of 
paperwork  and  the  enjoyment  of  a gener- 
al practice  as  an  Air  Force  flight  surgeon. 
Take  flight  with  today’s  Air  Force  and  dis- 
cover quality  benefits,  30  days  of  vaca- 
tion with  pay  each  year  and  the  support 
of  a dedicated  staff  of  professionals. 

Enjoy  a true  general  practice  on  the 
ground,  with  the  kind  of  stimulating  chal- 
lenge that  will  get  your  medical  skills  air- 
borne. Talk  to  an  Air  Force  medical  pro- 
gram manager  about  becoming  an  Air 
Force  flight  surgeon.  Call 

1-80Q-423-USAF 
USAF  Health  Professions 


378 


Colorado  Medicine  for  October,  1993 


The  times  and  places 
for  open  discussions  of 
physicians ' concerns 

October  22-24 
in  San  Francisco 

November  4-6 
in  Dallas 

November  19-21 
in  Philadelphia 


The  AMA  Brings  Washington  to  You. 

Shape  Your  Future 

at  the  Physicians'  Forum  on  Health 
System  Reform. 


Now  is  the  time  for 
direct  dialogue  with 
members  of  the  Administration 
and  Congress.  And  now,  the 
American  Medical  Association 
(AMA)  brings  you  the 
Physicians’  Forum:  Agenda  for 
Action , an  unprecedented 
opportunity  for  every  physician 
to  interact  with  policy  makers 
and  help  shape  the  way  health 
care  will  be  delivered. 

Speak  face  to  face  with 
Congressional  leaders, 
Presidential  advisors  and  top 
Administration  officials  on  the 
political  pressures  that  will 
ultimately  form  health  care 
policy.  Help  ensure  that 
patients’  needs  remain  the 
focus  of  reform.  Hear 
governors  and  heads  of  state 
health  departments  describe 
how  their  states  are  preparing 
for  a new  national  policy. 


The  Physicians'  Forum 

series  of  conferences  invites  all 
physicians,  not  just  AMA 
members,  to  join  the  dialogue 
on  issues  vital  to  their  practices. 
Physicians,  board  members  and 
officers  of  the  AMA  will  come 
together  to  reach  common 
ground. 

Voice  your  concerns  about 
the  coming  changes.  Do  not 
wait  passively  for  those  changes 
to  be  imposed  without  your 
input.  The  Physicians’  Forum  is 
the  time  and  place  to  speak  out 
and  make  an  impact. 

Your  attendence  is  crucial. 
Call  toll  free  800  621-8335. 

Conference  fee  for  meeting 
facilities  and  food  service — AMA 
members  $50,  nonmembers 
$125-  MasterCard,  Visa, 
American  Express,  Optima  are 
accepted. 


American  Medical  Association 

Physicians  dedicated  to  the  health  of  America 


Medical 


News 


Doctor  Hero? 

We  don't  usually  review  comic 
books,  but  you  might  be  interested  in 
this  one.  How  about  a comic  book 
where  the  hero  is  a physician?  It 
would  be  welcome  change  from  all 
the  negative  publicity  lately.  That's 
the  brainchild  of  Blake  B.  Jackson 
and  Grant  Fausey. 

Jackson  and  Fausey  say,  "We 
realize  that  doctor's  offices  have 
Highlights  and  Weekly  Reader  for 
the  young  kids  and  People  and 


Newsweek  for  the  grown-ups,  but 
nothing  to  speak  of  for  the  seven  to 
sixteen  year-old  patient." 

That's  part  of  the  reason  they 
created  EnForce,  a comic  about 
doctors,  nurses,  dentists,  and  — 
you'll  love  this  — the  villain  is  a 
lawyer.  And  while  it  is  amusing  your 
adolescent  patients,  it  is  also  forming 
a positive  image  of  the  medical 


profession  in  their  minds,  "While  it  is 
also  in  the  traditional  mold  of  a team 
of  comic  book  heroes,"  say  Jackson 
and  Fausey,  " EnForce  is  specifically 
designed  to  inspire  confidence  in  the 
medical  professionals  in  whose 
reception  areas  and  waiting  rooms 
patients  will  find  the  comic  book." 

The  comic  itself  is  very  politi- 
cally correct  and  even  New  Age  to 
some  extent,  but  your  young  patients 
will  certainly  find  it  engaging 
reading.  The  main  character  is  Dr. 
Tina  Matthews-Kerin,  a high  pow- 
ered and  voluptous  surgeon  in  a 


large  California  hospital.  There's  also 
a chiropractor,  a dentist,  the  hospital 
administrator,  an  ER  technician,  a 
male  nurse,  and,  of  course,  an 
ambulance-chasing  lawyer.  The 
explosion  of  an  alien  life-form  gives 
each  of  them  new  powers,  thus 
creating  EnForce , the  medical  super- 
heroes and  their  arch-enemy  Mega- 
Menace  (the  lawyer). 

For  more  information  about 
EnForce  write:  Reoccurring  Images 
Publishing  Group,  859  N.  Holly- 
wood Way,  Ste  422,  Burbank,  CA 
91505. 


J BioStar,  Inc. 

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380 


Colorado  Medicine  for  October,  1993 


Surgery  Resident 
Receives  Award 

Stephen  G.  Batuello,  MD,  a 
second-year  Surgery  resident,  has 
been  selected  to  receive  the  Ameri- 
can Medical  Association/Burroughs 
Wellcome  Co.  award  for  outstanding 
leadership  in  community  service.  Dr. 
Batuello  will  attend  and  be  recog- 
nized at  the  AMA  Interim  Meeting, 
December  2-5,  1993,  in  New 
Orleans,  and  the  AMA  Annual 
Meeting  , June  9-1 2,  1 994,  in 
Chicago,  the  award  carries  a $2,000 
stipend.  It  recognizes  resident 
physicians  and  fellows  who  have 
demonstrated  a commitment  to  their 
civic  or  medical  community  and  is 
intended  to  encourage  involvement 
with  organized  medicine  to  develop 
leadership  potential  among  the 
country's  brightest  and  most  caring 
residents. 

Dr.  Batuello  has  been  active  in 
community  service  for  many  years. 
He  has  participated  in  food  and 
clothing  drives,  served  in  food  lines 
for  the  indigent,  and  counseled 
troubled  adolescents.  He  organized  a 
series  of  retreats  for  faculty  and  staff 
at  Regis  College  to  promote  a 
service-oriented  mission,  volun- 
teered as  a lab  assistant  at  Channel  9 
Health  Fairs,  and  tutored  illiterate 
adults  in  Denver.  He  organized  a 
benefit  talent  show  for  the  C.  Henry 
Kempe  Center  for  abused  children, 
taught  AIDS  education  in  high 
schools,  volunteered  at  the  Stout 
Street  Clinic  for  the  Homeless  and 
served  on  the  University  of  Colorado 
School  of  Medicine  Admissions 
Committee.  In  addition  to  his  work 
in  the  community,  Dr.  Batuello 
established  and  occupied  a seat  for  a 

C nlnrarln  \A f>rl i ri nf>  fnr  Ortnhpr 


Medical 


medical  student  on  the  Colorado 
Medical  Society  Board  of  Directors 
where  he  helped  organize  a Medical 
Student  Component. 

Teaching  Physicians 

The  Stout  Street  Clinic,  a health 
care  facility  for  the  poor  and  home- 
less population  of  Denver  located  in 
downtown  Denver,  is  in  need  of 
primary  care  physicians  who  would 
be  interested  in  being  volunteer 
attendings  for  the  Saturday  morning 
student-run  clinic.  The  Saturday 
morning  session  runs  from  9:00  a.m.- 
1 2:00p.m.  during  the  school  year 
and  is  entirely  run  by  the  medical 
students  at  the  University  of  Colo- 
rado School  of  Medicine.  You  will 
be  working  with  all  levels  of  medical 
students  who  perform  the  jobs  of 
receptionist,  lab,  pharmacy,  nurse, 
and  physician.  You  would  be 
assigned  with  one  other  attending  to 
a team  of  students  and  would  work 
approximately  once  every  8 weeks. 
This  is  a great  opportunity  to  be  a 
role  model  for  students  and  to  help  a 
very  needy  population.  If  you  are 
interested  or  would  like  more 
information,  please  contact  Ann 
O'Brien,  M.S.N.,  Assistant  Director 
of  Predoctoral  Education  in  Family 
Medicine,  or  Gretchen  Swanson, 
Secratary,  at  270-5684  by  October 
31,  1993. 

New  Journal 

As  of  October  1 , 1 993  The 
American  Journal  of  Medicine  will 
become  the  official  publication  of 
the  Association  of  Professors  of 
Medicine  (APM).  In  addition  to 
publishing  original  peer-reviewed 
articles,  the  journal  will  present 
position  papers  that  primarily 
influence  medical/ethical  policies  on 

1 993 


health  care  issues,  medical  educa- 
tion, and  public  policy.  If  there  are 
any  questions  or  if  you  wish  to 
arrange  an  interview  please  contact 
Suzanne  Kleiner,  Healthcare  Promo- 
tions, Reed  Elsevier  Medical  Group 
at  (21 2)  463-6494. 

Regional  AMA 
meetings  to  expand 
communications 

Plans  for  three  regional  AMA- 
sponsored  meetings,  titled  "Physi- 
cians Forum:  Agenda  for  Action," 
have  been  announced  by  AMA 
President  Joseph  T.  Painter,  MD. 

The  goal  of  the  fall  meetings,  to 
be  held  in  San  Francisco,  Dallas  and 
Philadelphia,  will  be  to  expand  two- 
way  communications  between  the 
AMA  leadership  and  grass  roots 
physicians. 

"It  will  give  us  a chance  to  tell 
physicians — members  and  non- 
members alike  — what  the  AMA  has 
done  and  is  planning  to  do  on  their 
behalf,"  Dr.  Painter  said.  "We  also 
want  to  hear  from  those  physicians 
— about  their  problems,  their 
concerns,  their  activities." 

An  important  element  of  the 
regional  events  will  be  to  inform 
physicians  of  what  is  really  happen- 
ing in  government  today. 

"Given  the  stimulus  for  reform  or 
change  in  the  health  delivery  system, 
it  is  overwhelmingly  important  for 
the  profession  to  be  united  in 
understanding  of  goals  and  objec- 
tives, as  well  as  aware  of  and 
supportive  of  the  action  being  taken 
on  behalf  of  the  profession  by  its 
leadership,"  he  said. 

For  dates  and  locations  of  the 
three  meetings,  see  the  Calendar  of 
Events  section  of  this  publication. 

381 


October  1 , 1 993 


omponent  Society 


Executives 


The  following  is  a current  listing  of  the  CMS  Component  Society  staffed  offices, 
their  address,  phone  numbers  and  key  personnel. 


ARAPAHOE  MEDICAL  SOCIETY 

Brad  Darley,  Executive  Director 
Anne  Taylor,  Associate  Director 
777  East  Girard  Avenue 
Englewood,  CO  801 1 0 
FAX:  761-4026 
761-2887 

AURORA-ADAMS  COUNTY 
MEDICAL  SOCIETY 

Donna  Foss,  Executive  Secretary 
1675  South  Fairfax  Street 
Denver,  CO  80222 
FAX:  756-1967 
756-2718 

BOULDER  COUNTY  MEDICAL 
SOCIETY 

Judy  Ladd,  Executive  Director 
2769  Iris  Ave.,  #103 
Boulder,  CO  80304 
FAX:  444-2552 
545-6178. 

CLEAR  CREEK  VALLEY  MEDICAL 
SOCIETY 

Rene  Hawthorne-Shriver,  Executive 
Director 

7536  West  1 7th  Avenue 
Ladewood,  CO  8021  5 
FAX:  232-1593 
232-1428 

CURECANT1  MEDICAL  SOCIETY 

Kathy  Holman,  Executive  Secretary 
691 20  Vernal  Road 
Montrose,  CO  81401 
240-7350  Attn:  Kathy  Holman 
249-221  1 Ext.  397 


Medical  Executive  Group 

DELTA  COUNTY  MEDICAL 
SOCIETY 

Linda  Dodson,  Executive  Secretary 
100  Stafford  Lane,  #103 
Delta,  CO  8141 6 
874-7681  Ext.  281 

DENVER  MEDICAL  SOCIETY 

Kathy  Lindquist-Kleissler,  Executive 
Director 

Barbara  Kamerling,  Associate 
Director 

Catherine  Cray,  Membership 

Coordinator 

1 850  Williams  Street 

Denver,  CO  80218 

Fax: 331-9839 

377-1850 

EL  PASO  COUNTY  MEDICAL 
SOCIETY 

Carol  Walker,  Executive  Director 
Pam  Wahl,  Membership  Coordinator 
(719)  591 -8723-Membership 
2760  North  Academy  Blvd.,  #207 
Colorado  Springs,  CO  8091  7 
Fax:  (719)  591-5649 
(719)  591-2424 

LARIMER  COUNTY  MEDICAL 
SOCIETY 

Tammy  Nelson,  Executive  Director 

1024  Lemay  Avenue 

Fort  Collins,  CO  80524 

Fax: 495-7601 

495-7151 


MORGAN  COUNTY  MEDICAL 
SOCIETY 

Ronnah  Hernandez 
P.O.  Box  767 
Fort  Morgan,  CO  80701 
867-4823  or  867-2051 

NORTHEAST  COLO  MEDICAL 
SOCIETY 

LaVonne  Bilyeu,  Staff  Support 

Plains  Radiology 

P.O.  Box  1432 

Sterling,  CO  80751 

Fax:  522-5185 

522-6386 

PUEBLO  COUNTY  MEDICAL 
SOCIETY 

Peggy  Fogel,  Executive  Secretary 
1 925  East  Orman  Avenue 
Pueblo,  CO  81 004 
(719)  542-0106  (answering  service) 
(719)  564-9109 

WELD  COUNTY  MEDICAL 
SOCIETY 

Pennie  Joseph,  Executive  Director 

North  Colorado  Medical  Center 

1801  16th  Street 

Greeley,  CO  80631 

Fax:  350-6107  Attn:  Medical  Society 

353-2596 

WESTERN  SLOPE  MEDICAL 
SOCIETIES 

(Mesa  - Intermountain  - Mt.  Sopris) 

Dolores  Bennett,  Executive  Secretary 

1 1 20  Wellington,  #206 

Grand  Junction,  CO  81  501 

Fax:  243-2808 

243-2808 


382 


Colorado  Medicine  for  October,  1993 


New  Member 


ARAPAHOE  MEDICAL  SOCIETY 


Eli  G Goodman,  MD 
1919  S University  Blvd 
Denver,  CO  80210 
Elected  07/20/93 

Gary  L McDonald,  MD 
799  E Hampden  Ave  #510 
Englewood,  CO  801 1 0 
Elected  05/20/93 

Peter  M Nicholson,  MD 
3900  E Mexico  Ave 
Denver,  CO  80210 
Elected  07/20/93 

Catherine  L Wikoff,  MD 
7400  E Hampden  Ave 
Denver,  CO  80231 
Elected  04/20/93 


AURORA-ADAMS  COUNTY 
MEDICAL  SOCIETY 

Dale  E Varner,  MD 
840  F S Vance  St 
Lakewood,  CO  80226 
Elected  08/1  3/93 


CLEAR  CREEK  VALLEY  MEDICAL 
SOCIETY 

Jeremy  K Law,  MD 
5208  S Geneva  St 
Englewood,  CO  801 1 1 
Elected  08/19/93 


DENVER  MEDICAL  SOCIETY 


Diane  C Barta,  MD 

9057  E Mississippi  Ave  #1  5-201 

Denver,  CO  80231 

Elected  08/01/93 

Rebecca  J Brock,  MD 
4999  E Kentucky  Ave 
Denver,  CO  80222 
Elected  08/01/93 


Kenneth  S Greenberg,  DO 
4545  E 9th  Ave  #005 
Denver,  CO  80220 
Elected  08/01/93 

Judson  F Lloyd,  MD 
2330  Washington  St  #303 
Denver,  CO  80205 
Elected  08/01/93 

Kenneth  W Niejadlik,  MD 
UCHSC 

4200  E 9th  Ave  #B-1 1 3 
Denver,  CO  80262 
Elected  08/01/93 


Joseph  W Strausburg,  MD 
2559  S Xenophon  St 
Lakewood,  CO  80228 
Elected  08/01/93 

Hannis  W Thompson,  MD 
4200  E 9th  Ave  #B-128 
Denver,  CO  80262 
Elected  08/01/93 


OTERO  COUNTY  MEDICAL 
SOCIETY 

Eleuterio  G Acosta  Jr,  MD 
421  W 3rd  St 
La  Junta,  CO  81050 
Elected  08/23/93 


^Stfeul 

Medical  Services 

Specialists  in  Medical 
Liability  Insurance 

St.  Paul  Fire  and  Marine  Insurance  Company 

Denver  Service  Center 
12250  E.  Iliff  Avenue,  Suite  400 
Aurora,  Colorado  80044 

303.696.7500 


For  more  information  about  The  St.  Paul's  medical  professional 
liability  insurance  contact  your  independent  insurance  agent  or  the 
Denver  Service  Center. 


Colorado  Medicine  for  October,  1993 


383 


Classified  Advertising 


Publication  of  any  advertisement  in  Colorado  Medicine  is  not  an  endorsement  by  the  Colorado  Medical  Society 
of  the  product  or  service.  Colorado  Medicine  magazine  is  the  official  journal  of  the  Colorado  Medical  Society,  and 
is  authorized  to  carry  General  Advertising. 


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9548,  FAX:  (602)  433-9548.  3/0893 


EMERGENCY  PHYSICIAN,  Denver,  CO.  F/ 
P Time  BC/BE  EM  or  Primary  Care  w/  ER 
experience.  MarkTalmage,  MD,  (303)  369- 
1 1 46  or  CV  to  Southeast  Denver  Emergency 
Physicians,  PC  875  S.  Colorado  Blvd.#653, 
Denver,  CO.  80222.  2/0893 

LOCUM  TENENS...  new  adventures,  free 
from  administrative  tasks,  flexibility,  and 
high  earnings.  Assignments  vary:  one  day, 
one  week,  one  month,  long  term,  OR,  time 
off  with  peace  of  mind,  knowing  that  your 
practice  goes  uninterrupted.  Qualified 
physicians  are  ready  to  assist.  Ten  years 
experience;  physician-managed  company. 
Call  INTERIM  PHYSICIANS  today  for 
details. — Denver691  -071 8,  or  1 -800-669- 
0718  12/1292 

PHYSICIANS,  (MD/DO)-  Part-time 
practice,  Denver,  Flight  surgeon,  Disaster 
& Occupational  Medicine.  Expand  your 
horizon  with  the  Air  National  Guard.  Call 
EDD  (307)772-6185.  The  Air  National 
Guard.  9/0293 


TIRED  OF  THE  DAY  TO  DAY  HASSLE  of 

HMO's,  Medicare,  discounted  insurance 
and  being  on  call!1  Then  consider  a position 
with  corrections.  Before  you  say  "No  Way," 
call  us  and  find  out  more.  Contact  Roderic 
Gottula,  MD,  10900  Smith  Road,  Denver, 
CO  80239  or  call  (303)  375-21  1 0.6/0793 

BOULDER  - Urgent/Family/Occupational 
Medicine  - Successful  Medical  Center 
seekingtwo  BE/BC  physicians  for  excellent 
opportunity  in  prime  SE  Boulder  area. 
Minimal  call  Flexible  scheduling.  Send  CV 
and  call  Dr.  Turnbow,  Meadows  Medical 
Center,  P.C.,  4800  Baseline,  D-106, 
Boulder,  CO.  80303.  (303)  499-4800. 

4/0893 

♦ SITUATIONS  WANTED 

RN  EXPERIENCED  21  years  same  medical 
office  desires  challenging  medical  office 
position.  Very  flexible  S/E  Denver.  324- 
2927.  3/0993 

♦ PROPERTIES  FOR  SALE  OR  LEASE 

HORSE  FARM  OF  YOUR  DREAMS! 
Restored  original  homestead  dates  to  1 894. 
Lg.  country  kit.  by  Kline,  Subzero, 
Modernmaid  appl.  3 bdrms,  2 1/2  baths, 
mastersuite  w/fireplace,  2710  sq.  ft.  All 
this  and  more  on  Ida  Mtn.  Meadow  near 
Conifer  • live  spgs.»  3 barns  • 30  stalls* 
indoor  arena  • $1 500/mo.  income  from 
lease  of  stalls  and  bunkhouse  • $1000 /mo 
in  depreciation  of  bldgs.  & equip.  Call 
Michael  Paul,  RE/MAX  Masters,  741  -1 400 
or  688-2078.  1/1093 

ELEGANT  ESTATE  VV/CITY  VIEW!  Framed 
by  Red  Rocks,  gracious  country  lifestyle 
just  4 min.  from  C-470  and  city  amenities. 
6700  sq.  ft.  finished  living  area,  5 bdrms,  5 
baths,  plantation  shutters,  marble  firs., 
wine  cellar,  hot  tub  and  hrs.  barn  on  6 acre 
hilltop.  $795,000.  Want  more  room?  14 
more  acres  avail,  or  divide  extra  acres  into 
3 or  4 prime  res.  lots.  Adjacent  to  Jeffco 
open  space.  Call  Michael  Paul,  RE/MAX 
Masters,  741-1400  or  688-2078.  1/1093 


JEWELL  & WADSWORTH-  Retail/office 
space  for  lease  - excellent  exposure  - free 
standi ng  building  -2000  square  feet  $1  375/ 
month.  Tenant  finish  $$  available.  Call 
Billy  Halax  973-1380  6/0593 

OFFICE  SPACE  FOR  LEASE-  Newly 
decorated  suite  in  existingOB/GYN  practice 
at  Mission  Trace  Shopping  Center  (near 
Wadsworth  & Hampden).  1 treatment  and 
1 consultation  room  just  right  for  FP  or 
other  primary  care.  High  traffic  area,  great 
potential.  Call  Gail  at  (303)  424-7877. 

1/1 093 


CUT  OVERHEAD 

Share  office  space  in  beautiful  modern 
building  with  agreatview.  DTC  location. 
Full  or  part  time,  ideal  for  any  specialty 
except  pediatrics.  A fully  equipped 
surgical  suite  available  on  site.  This  is  an 
excellent  opportunity  to  enjoy  a modern 
well-equipped  facility  at  a reasonable 
cost.  Call  Lisa  - 773-3455  4/0793 


MEDICAL  OFFICE  SPACE  ALREADY  BUILT 
OUT  AND  PAID  FOR.  Save  your  $$$$$'s. 
Greenwood  Village  location;  1 -1/2  blocks 
west  of  l-25/Belleview  interchange,  very 
easy  for  patients  to  find.  3,188  rentable 
square  feet.  Extensive  medical  finishes  and 
upgrades  throughout,  x-ray  machine, 
cabinets,  desks,  phone  system,  all  available 
for  purchase.  Property  managed  on-site- 
Available  for  immediate  occupancy. 
Contact  CB  Commercial  Fairbairn/Ogilvie 
(303)  799-1800. 

MEDICAL  OFFICE  SPACE  AVAILABLE-  in  a 
Professional  building.  General  Practitioner 
needed  in  the  area.  Location  at  28  south 
Broadway  at  Ellsworth.  Please  call  744- 
7193.  1/1093 

♦ EQUIPMENT  FOR  SALE  OR  LEASE 

BUY  DIRECT— LOCAL  MFGR.  Custom 
Office  Furniture — Desks,  Credenzas, 
bookcases,  Files,  work  stations,  waiting 
room  seating,  etc.  Oak-cherry  & walnut. 
We  build  quality  custom  office  furniture  at 
a price  you  can  afford.  Mark  IV  Systems, 
Inc.  297-1 248.  8:00-4:30  M-F.  1 2/0293 


384 


Colorado  Medicine  for  October,  1993 


EQUIPMENT  FOR  SALE:  Motorola  STX 
Two-Way  FM  radio  phone  complete  with 
charger  and  leather  holster,  excellent 
condition  $300;  TEAC  model  B9  EMG  & 
NVC  machine,  all  leads  and  accessories, 
excellent  condition,  $500;  Murata  model 
1 200  fax  machine,  in  good  condition,  $1 50. 
contact  Dr.  Lee  Gordon  at  (303)  221- 
2827.  1/1093 

FOR  SALE-  Complete  office  automation 
system.  AMS  Practice  Plus  multi-use  work 
station.  Includes  two  386  computers, 
internal  modem,  VGA  monitors,  brand  new 
24-pin  printer,  LAN  setup  and  all  software. 
Support  system  and  license  transferred  to 
new  owner  at  no  charge.  Asking  $3,000 
(software  alone  worth  $ 7,000).  Cal  I Beverly 
at  (303)  867-5532  1/1093 

DUE  TO  INCREASED  CLIA  REGULA- 
TIONS, Moffat  Family  Clinic  is  offering  the 
following  equipment  for  purchase.  Abbott 
Vision  Machine,  IMEX  Lab  9000  Periferal 
Vascu  lar  System  and  QBC  Reference  System 
Hematology  Analyzer.  For  information 
piease  contact  Moffat  Family  Clinic,  600 
Russell,  Craig,  CO  81 625  or  call  (303)  824- 
3252.  contact  person  - Judy  Milner,  office 
manager  or  Larry  Kipe,  MD.  34/1093 

♦ SERVICES 

EXPERIENCED  MEDICAL  TRANSCRIP- 
TIONIST — Surgery/Clinic  dictation — ENT, 
Gl,  General  Surgery,  Neurology,  OB/GYN, 
Orthopedics/Podiatry,  Rheumatology, 
Pediatrics,  Plastics.  Fast,  accurate  — IBM 
PC,  WP  5.1,  Format/Laser  Print.  Home: 
(303)  329-6572/  FAX:  (303)  329-8266. 

3/0993 

QUICK  CLAIM  ELECTRONIC  CLAIMS 
PROCESSORS,  HMO  PPO,  MEDICARE, 
MEDICAID  AND  PATIENTS  BILLING  (303) 
333-8666.  22/0393 

HOME  MORTGAGE  LOANS 
LOW  DOC  PROGRAM  available  for 
physicians  and  other  health  professionals. 
Purchase  and  refinance.  Call  Milt,  a 
mortgage  banker  with  1 8 years  experience. 
753-6262.  12/1292 


WE  BUY  MORTGAGE  NOTES-  Get  your 
money  out  - National  Iwnders  will  buy 
notes  from  $30,000  and  up.  Must  have  all 
deeds.  Call  Marian  at  740-7918.  1/1093 

INNOVATIONS  SHOULD  BE  PATENTED 

if  marketable.  For  more  information  call 
Brian  D.  Smith  of  Fields,  Lewis,  Pittenger  & 
Rost.  Colo's  leading  patent  law  firm.  Mr. 
Smith  specializes  in  the  medical  arts.  (303) 
758-8400.  12/1192 

RESIDENTIAL  REAL  ESTATE  SALES.  Dealing 
in  homes  valued  above  $250,000.  1 2 yrs. 
exper.  BS:  Real  Estate  and  Construction 
Mgmt-D.U.  MS:  Finance  & Tax  - C.U. 
Steven  Carter,  Pres.  Flatiron  RE  Serv. 
Denver/Boulder  (303)888-0521  1 2/0893 

If  the  objective  is  financial  independence... 
there  is  another  way...  Outsourcing 
through  Clinic  Service  Corporation. 
Established  in  1974  simply  as  a billing 
service,  today  we  offer  Colorado's  most 
extensive  practice  management  package. 
Expandable,  CSC  systems  grow  to  meet 
your  demands.  For  more  information  and 
references  please  call  Yvette  Schrock  at 
777-9674.  4/0893 


LOOKING  FOR  QUALITY  HOME  HEALTH 
CARE?  Refer  your  patients  to  a non-profit, 
bonded  and  certified,  total,  affordable  home 
care  service,  call  Betty  at  740-0024. 

1/1093 


BUY-SELL  AGREEMENTS/PARTICI- 
PATING PROVIDERCONTRACTS.  Legal 
assistance  in  the  negotiation  and 
documentation  of  practice  purchases  and 
sales,  and  provider  agreements.  Former 
Blue  Cross  Attorney.  James  E.  Gigax, 
Esq.,  410  - 17th  Street,  Suite  2400, 
Denver,  CO.  80202;  (303)  534-2277.2/ 
1093 


♦ MISCELLANEOUS 

EQUIPMENT  NEEDED  URGENTLY  for 

large  community  health  center  located  in 
Longmont.  Our  five-exam  room  facility 
will  soon  expand  to  1 2 exam  rooms  and  we 
are  looking  for  good  used  office  equipment 
and  exam  room  furnishings.  Call  to  discuss 
price/donations  with  Mark  Kissack  at  (800) 
388-4325.  6/0393 


Donald  J.  Northey,  M.A. 

Clinical  Audiology 
Audiological  Consultants,  Inc. 

• General  Audiology 
• Hearing  aid  evaluations 
• Hearing  aid  dispensing,  service  and  aftercare 
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• Noise,  swim  and  surgical  ear  plugs 
• Electronic  Shooters  Protection 
ENGLEWOOD  LAKEWOOD 

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Colorado  Medicine  for  October,  1993 


385 


Ruminations 


(def:  chewing  again  what  has  been  chewed  slightly  and  swallowed;  to  REFLECT) 


by  Bill  Pierson , Managing  Editor 


"He  had  been  stabbed 
. . . and  the  blade  had 
found  the  big  artery. " 


It  was  just  last  month  we 
published  Dr.  Thomas  Coleman's 
article,  "Entertainment  is  killing  us!" 
and  I had  ruminated  on  my  bygone 
views  of  the  world  and  how  the 
Pope's  visit  to  Denver  had  rocked 
"my  world".  I spoke  of  contrast  as  I 
talked  about  how  other  people  were 
impacting  my  world.  How  severely, 
you  ask?  Try  this  on  for  size: 

It  was  the  first  Friday  in  Septem- 
ber, and  the  September  magazine 
was  already  in  print.  I met  my  wife 
about  8:30  p.  m.  at  an  office  I have 
in  lower  downtown  Denver.  We 
were  going  to  leave  her  car  there 
and  drive  together  to  our  home  in 
Georgetown.  I had  a few  things  to 
get  from  my  office  (on  the  second 
floor);  while  I was  busy  I heard  a 
commotion  outside  in  the  street: 
siren,  urgent  voices,  the  sounds  of  an 
emergency. 


I ran  down  the  hall  to  a window 
and  I saw  below  a Denver  police- 
man working  over  a body  lying 
spreadeagled  on  the  curbing  at  the 
entrance  to  my  building  garage.  Just 
then  an  ambulance  arrived  and  the 
EMTs  started  ministering  to  the  man, 
non-descript  in  worn  denim  pants 
and  jacket  already  deep  crimson, 
even  in  the  dim  light  of  the  street 
lamp.  He  was  bleeding  profusely. 

The  EMTs  and  policemen  (now 
there  were  three)  worked  feverishly 
and  expertly  in  their  attempts.  They 
were  joined  in  seconds  by  a Denver 
Fire  Department  rescue  squad.  It 
soon  became  obvious  the  man 
wasn't  going  to  make  it.  He  had 
been  stabbed  in  the  upper  right  thigh 
and  the  blade  had  found  the  big 
artery. 

There  was  no  help  on  the  street; 
it's  an  area  inhabited  by  many  a 
vagrant,  itinerant,  day-labor  type  and 
a fallen-down  drunk  is  not  an 
uncommon  site.  But  this  man  died 
on  the  spot.  He  had  managed  to 
crawl  about  20  yards,  but  found  no 
solace.  He'd  been  down  about  ten 
minutes  by  the  time  help  reached 
him...  a lone  police  officer  who 
placed  a tourniquet  on  the  man's  leg 
trying  to  stem  the  flow. 

I couldn't  be  of  help.  I was 
uninvolved  but  forced  to  look  into 
another  world  which  had  just 
slammed  up  against  my  backside. 
There  I stood  at  the  window  watch- 
ing this  total  and  absolute  drama  of 
life  and  death  and  the  crime  scene 
investigation  which  followed.  Within 
fifteen  minutes  there  were  seven 
Denver  Police  vehicles,  nine  officers, 
a fire  engine  and  an  ambulance.  The 
crime  scene  was  cordoned  off  and 


remained  sealed  into  Saturday 
morning  as  the  investigators  did  their 
grisly  work.  There  I was,  forced  to 
watch.  My  wife  and  I were  the  only 
bystanders,  trapped  in  this  world  of 
street-violence.  There's  not  much 
interest  demonstrated  by  passers-by 
in  this  area  when  police  are  involved 
(In  fact,  police  tend  to  cause  on- 
lookers to  disappear  quickly). 

I recount  this  here  because  of  the 
extremes  in  juxtaposition:  one 
minute  describing  how  worlds  touch 
one  another  and  how,  in  my  child- 
hood, "violence  was  totally  a 
'grown-up'  thing  in  far-off  places", 
and  the  next  minute  watching  the 
mechanics  of  death  of  an  absolute 
stranger  take  place  less  than  35  feet 
from  me,  a result  of  the  very  street 
violence  we  have  been  talking 
about. 

This  unknown  man's  horrible 
death,  for  whatever  reason,  earned 
him  less  than  2 column  inches  in 
Sunday  morning's  newspaper  and 
never  another  mention  as  far  as  I 
could  see. 

The  weapon  wasn't  found.  The 
person  who  stabbed  him  was  never 
any  more  than  a shadow  in  the  night. 
A motorist  saw  the  victim  crawling 
across  the  street  and  called  the 
police.  The  victim  was  probably 
even  a visitor  to  Denver,  although 
not  a "tourist",  but  none  of  these 
things  made  much  news. 

I realized  that  it  is  no  longer 
someone  else's  world  I'm  looking 
into.  This  is  my  world  and  I cannot 
view  it  as  some  stranger's  incursion 
into  my  otherwise  neat  and  tidy 
place.  I have  to  deal  with  it. 

Life  (or  death)  just  doesn't  work 
that  way  any  more. 

7 C/M 


386 


Colorado  Medicine  for  October,  1993 


j 


"Advocating  excellence  in  the  profession  of  medicine" 


i This  Issue: 

Making  a difference  on  national,  state  and  local  levels Wm.  Carl  Bailey,  MD 

Lessons  from  saddle  sores  and  waltzing  with  gorillas Sandra  L.  Maloney 

Life  after  health  care  reform?  Sure! Frederick  A.  Lewis,  lr„  MD 

Women's  health  in  the  national  limelight Patricia  Schroeder 


Can  you  imagine  a physician  who  would  run  a classified  advertisement  like  that? 

Of  course  not.  And  yet,  some  Colorado  physicians  choose  their  malpractice 
insurance  carrier  that  way  Unfortunately,  when  they  sort  through  the  fine  print 
of  their  policy  they  often  discover  that  Brand  X wasn’t  even  the  low  bidder,  let 
alone  the  most  competent  to  avoid  or  defend  malpractice  suits,  or  to  provide 
vital  services  to  policyholders  and  the  Colorado  physician  community  By 
all  means,  comparison  shop  if  you’re  in  the  market  for  malpractice  insurance. 
But  when  you  do,  be  certain  that  you  make  your  choice  based  on  all  the  facts 
and  figures.  ♦♦♦  We  are  confident  that  you  will  choose  Copic.  More  often  than 
not,  we  will  be  the  low  bidder,  once  you  reach  the  real  bottom  line. 

The  Copic  Bottom  Line . 

It’s  more  than  just  competitive  rates. 


Cpic 


Copic  Insurance  Company 

PO.  Box  17540  • Denver,  CO  80217-0540  • (303)  779-0044  • 1-800-421-1834 


Colorado 

November,  1993 


Medicine 

Volume  90,  Number  11 


Cover  Story 


Your  Colorado  Medical  So- 
ciety is  busy  representi ng  your 
interests  in  all  arenasof  health 
system  reform.  Several  sto- 
ries in  this  issue  explain. 


Departments 


396  President's  Letter 

398 Executive  Director's  Update 

404The  Lobby 

406Health  Care  Policy 

414Heaith  Care  Financing 

41  5 Definitions 

41  7 Health  Department 

41 8Medical  News 

420Classified  Advertising 

422  Ruminations 


n This  Issue... 


396  "Always  do  right" 


Wm.  Carl  Bailey,  MD 

400  Women's  Health:  A Washington,  DC  perspective 

Patricia  Schroeder,  First  Congressional  District 

402  TB:  The  Forgotten  Plague — A book  review 

Thomas  H.  Coleman,  MD 

41  2 Health  care  reform  is  now  entertainment 

41 6 An  explanation  of  member  services 

William  S.  Pierson,  Managing  Editor 


Colorado  Medical  Society 


COLORADO  MEDICAL  SOCIETY 
OFFICERS,  BOARD  MEMBERS  and  AMA  DELEGATES 


1992/1993  Officers 
Wm.  Carl  Bailey,  M.D. 

President 

David  C.  Martz,  M.D. 

President-elect 
Terrance  J.  Sullivan,  M.D. 

Treasurer 

Stuart  O.  Silverberg,  M.D. 

Speaker  of  the  House 

Ted  T.  Lewis,  M.D. 

Vice-speaker  of  the  House 

Sandra  L.  Maloney 

Secretary/Executive  Director 

Leigh  Truitt,  M.D. 

(Immediate  Past  President) 


Board  of  Directors 

Board  of  Directors 

Thomas  J.  Allen,  MD 

Denis  J.  Winder,  MD 

Stephen  G.  Batuello,  MD 
)ohn  O.  Cletcher,  Jr.,  MD 

M.  Robert  Yakely,  MD 

Donald  G.  Eckhoff,  MD 
John  E.  Ell  iff,  MD 

AMA  Delegates 

Jonathan  C.  Feeney,  MD 

M.  Ray  Painter,  Jr.,  MD 

Joel  M.  Karlin,  MD 

Richert  E.  Quinn,  Jr.,  MD 

David  M.  Knize,  MD 
Robert  L.  Kruse,  MD 

Mark  A.  Levine,  MD 

Muryl  L.  Laman,  MD 
John  B.  Muth,  MD 

Alternate  Delegates 

Theresa  A.  Scholz 

Robert  D.  McCartney,  MD 

Louise  L.  McDonald,  MD 

Robert  M.  Bogin,  MD 

Robert  A.  Nathan,  MD 
Lothar  K.  Roller,  MD 

Joel  M.  Karlin,  MD 

Elaine  N.  Scholes,  MD 

Robert  R.  Montgomery, 

W.  George  Shanks,  MD 
Susan  A.  Sherman,  MD 

Legal  Counsel 

COLORADO  MEDICAL  SOCIETY  STAFF 


Executive  Office 

Division  of  Flealth  Care  Policy 

Sandra  L.  Maloney,  Executive  Director 

Ellen  J.  Stein,  Director 

Mary  Lee  Johnston,  Executive  Admin.  Asst. 

Marilyn  P.  Barton,  Program  Manager 

Nancy  L.  Deter,  Manager,  Accounting 

Lynn  R.  Livingston,  Administrative  Assistant 

Western  Slope  Office 

Division  of  Health  Care  Financing 

Dolores  M.  Bennett,  Executive  Secretary 

Edie  K.  Register,  Director 

Division  of  Membership  Information  Services 

Timothy  H.  Roberts,  Director 

Marijo  M.  Parkin,  Program  Manager 

Division  of  Government  Relations 

Diane  L.  LeHew,  Manager,  Support  Services 

Sue  Ellen  Quam,  Director 

Debra  M.  Jones,  Membership  Coordinator 

Lorraine  L.  Koehn,  Program  Manager/Lobbyist 

Beth  M.  Crusha,  Administrative  Assistant 

K.  Suzanne  Hamilton,  Administrative  Assistant 

Division  of  Professional  Services 

Division  of  Communications 

Sandra  M.  Finney,  Director 

William  S.  Pierson,  Director 

Lorraine  K.  Heth,  Program  Manager 

Michael  P.  Thompson,  Communications  Mgr. 

Kirsten  E.  Spilde,  Secretary 

Gil  Maestas  II,  Communications  Specialist 

COLORADO  MEDICINE  (ISSN-01 99-7343)  is  published  monthly  as  the  officialjournal  of  the  Colorado  Medical  Society,  7800  E.  Dorado  PI.,  Englewood,  CO  801 1 1 . Telephone  (303)  779-5455.  Outside 
Denver  area,  call  1 -800-654-5653.  Second  Class  postage  paid  at  Englewood,  Colorado,  and  at  additional  mailing  offices.  POSTMASTER,  send  address  changes  to  COLORADO  MEDICINE,  P.  O.  BOX 
1 7550,  Denver,  CO  80217-0550.  Address  all  correspondence  relating  to  subscriptions,  advertising  or  address  changes,  manuscripts,  organizational  and  other  news  items  regarding  the  editorial  content 
to  the  editorial  and  business  office.  Subscriptions  are  available  for  $30  per  year,  paid  in  advance. 

COLORADO  MEDICINE  magazine  is  the  official  journal  of  the  Colorado  Medical  Society,  but  as  such  is  also  authorized  to  carry  general  advertising.  Publication  of  any  advertisement  in  COLORADO 
MEDICINE  does  not  imply  an  endorsement  or  sponsorship  by  the  Colorado  Medical  Society  of  the  product  or  service  advertised.  Published  articles  represent  opinions  of  the  authors  and  do  not  necessarily 
reflect  the  official  policy  of  the  Colorado  Medical  Society  unless  clearly  specified. 

Sandra  L.  Maloney,  Executive  Editor;  William  S.  Pierson,  Managing  Editor;  Michael  Thompson,  Asst.  Managing  Editor,  Gil  Maestas,  II,  Communications  Specialist 


Member,  Colorado  Press  Association, 


G 


Member,  Colorado  Broadcasters  Association 


392 


Colorado  Medicine  for  November,  1993 


Computer  Talk 

Medical  Practice  Automation  Issues  & Information 

a service  of 

/MicroAge 

8620  Wolff  Court  - Westminster,  CO  80030  (303)  427-2121 


Keeping  a Handle  on  PPO's 


There  are  probably  two 
things  a computer  system  should  be 
able  to  provide  you  with  to  be  of  any 
real  value.  The  first  is  the  increased 
productivity  of  your  office  staff 
through  the  automation  of  routine 
clerical  functions.  The  second  is  the 
transformation  of  the  raw  data  stored 
in  your  system  into  useful  informa- 
tion. In  this  issue,  we  focus  on  some 
data  and  information  issues. 

Now,  every  respectable 
medical  practice  computer  system 
today  will  provide  a menu  of  standard 
reports.  And.  beyond  that,  many  will 
permit  you  to  create  custom  reports 
based  on  your  own  criteria  (e.g., 
patients  who  came  in  between 
January  and  March  of  this  year  for  a 
routine  mammogram,  who  are 
covered  by  Medicare.  Just  how  easy 
it  is  to  accomplish  this  is  another 
Computer  Talk  entirely.)  But  the 
system's  reporting  capability  will 
always  be  limited  by  the  data  it  stores. 
For  example,  it  is  simply  no  good 
asking  for  a list  of  charges  billed 
more  than  90  days  ago,  if  your  system 
doesn't  store  the  date  billed , only  the 
date  of  sendee. 

There  is  one  key  reporting 
area  many  software  programs  are 
scrambling  to  keep  up  with,  and  that 
concerns  PPO  information  manage- 
ment. PPO's  have  become  a way  of 
life  for  most  medical  practices,  and  if 
you're  contracting  with  them,  you  will 
certainly  benefit  from  software  that 
can  help  you  get  a handle  on  them. 

Some  examples: 

1.  Payment  tracking.  Are  you 
being  paid  what  you're  con- 
tracting for  on  each  procedure? 

Your  software  should  be  capable 
of  storing  this  information  in  two 


ways:  First,  by  multiplying  each 
procedure's  unit  value  by  the 
PPO's  own  conversion  rate.  This 
will  give  you  the  amount  the  PPO 
is  supposed  to  be  allowing  for 
each  procedure  (not  necessarily 
the  amount  they're  paying). 
Second,  the  system  should  permit 
you  to  keep  an  allowable  amount 
table  for  each  procedure,  for  each 
PPO,  based  on  their  own  fee 
schedule. 

The  sofware  should  calculate  the 
actual  payment  amount  using 
each  patient's  own  particular  plan 
(100%  of  the  allowed  amount,  or 
80%  of  the  allowed  amount,  etc.) 
In  this  way  your  computer  will  be 
able  to  tell  you  when  you  are 
being  underpaid,  perhaps  even 
alerting  the  operator  when 
posting  payments,  so  that 
appropriate  appeal  procedures 
can  be  started.  Also,  it  is 
important  to  keep  in  mind  the 
sophistication  of  these  plans. 
Procedure  conversion  rate 
multipliers  are  provided  in  your 
PPO  contract  by  type  of  service; 
medical,  surgery,  anesthesiology, 
pathology,  and  radiology.  To 
further  complicate  matters,  each 
type  of  service  may  carry  its  own 
deductible. 

2.  PPO  performance  statistics. 
How  do  your  PPO's  stack  up? 

What's  the  lowest,  highest  and 
average  amounts  each  PPO  is 
paying  for  each  procedure?  This 
information  can  be  extremely 
useful  when  you  are  evaluating  a 
new  PPO  contract.  Also  consider 
how  long  they  take  to  pay.  Who 
pays  the  quickest?  The  slowest? 

3.  Real  time  prediction.  If  your 


system  stores  all  the  above 
information  on  your  PPO  con- 
tracts, when  your  patients  are 
being  checked  out  you  should  be 
able  to  post  their  charges  right 
then  and  tell  them  exactly  what 
their  responsibility  is,  thus  saving 
valuable  collection  time.  Nor- 
mally, first  you  bill  the  PPO. 

Four  to  six  weeks  later  they  pay 
you.  Next  statement  cycle,  you 
bill  the  patient.  Next  paycheck, 
they  pay  you.  Total  collection 
time  for  the  patient's  portion:  six 
to  twelve  weeks.  Add  this  up  for 
all  your  PPO  patients'  outstanding 
responsibilities  and  it  could  come 
to  quite  a sum.  Why  not  get  the 
money  up  front,  if  your  computer 
can  help  you?  Many  practices 
have  switched  to  real  time  posting 
for  this  very  reason.  But  be 
careful.  If  your  system  is  not 
accurate,  or  if  it  is  only  estimat- 
ing, not  calculating,  you  could 
end  up  spending  lots  of  time 
dealing  with  a zillion  $2  refunds. 
Also,  it  is  important  to  note  that 
some  contracted  plans  do  not 
permit  up-front  collection,  e.g. 
Medicare.  In  these  cases  you 
must  bill  and  collect  from  the 
insurance  carrier  before  asking  the 
patient  for  payment. 

If  your  system  doesn't 
provide  you  with  PPO  help,  contact 
your  vendor.  It  is  only  by  listening  to 
requests  from  users  like  you  that  they 
can  hope  to  remain  competitive. 

To  be  fair,  though,  insurance 
companies  make  PPO's  a swiftly 
moving  target  for  software  vendors. 

And  what  about  health-care 
reform  and  the  future  of  PPO's? 

Stay  tuned. 


Colorado  Medicine  for  November,  1993 


393 


The  AM  A Brings  Washington  to  You . 

Shape  Your  Future 

at  the  Physician’s  Forum  on  Health 
System  Reform . 


The  time  and  place  for 
open  discussion  of 
physicians'  concerns 

November  19-21 
in  Philadelphia 


Program  and  speakers: 

Washington  & You 

Philip  R.  Lee , M.D. , Assistant  Secretary  for 
Health,  Health  and  Human  Services 

Legislation  and  You 

Sen.  John  D.  Rockefeller,  IV,  (D-WVa) 

Sen.  Aden  Specter,  (R-PA) 

Rep.  Charles  Rangel,  (D-NY,  15th  CD) 

Rep.  William  Thomas,  (R-CA,  21st  CD) 

The  Future  of  Physicians 

Louis  B.  Sullivan,  M.D. 

The  State  Picture  (Invitations  pending  ) 

Robert  P.  Casey,  Gov.  of  Pennsylvania 
Howard  Dean,  Gov.  of  Vermont 
Mario  Cuomo,  Gov.  of  New  York 
Mark  Chassin,  M.D.,  NY  Comm,  of  Health 
Commissioner  of  Tennessee  State  Health  Dept. 
Commissioner  of  Kentucky  State  Health  Dept. 


Now  is  the  time  for 
direct  dialogue  with 
members  of  the  Administration 
and  Congress.  And  now,  the 
American  Medical  Association 
(AMA)  brings  you  the 
Physician's  Forum:  Agenda  for 
Action,  an  unprecedented 
opportunity  for  every  physician 
to  interact  with  poilicy  makers 
and  help  shape  the  way  health 
care  will  be  delivered. 

Speak  face  to  face  with 
Congressional  leaders, 
Presidential  advisors  and  top 
Administration  officials  on  the 
political  pressures  that  will 
ultimately  form  health  care 
policy.  Help  ensure  that 
patients'  needs  remain  the 
focus  of  reform.  Hear 
governors  and  heads  of  state 
health  departments  describe 
how  their  states  are  preparing 
for  a new  national  policy. 


The  Physician 's  Forum 

series  of  conferences  invites  all 
physicians,  not  just  AMA 
members,  to  join  the  dialogue 
on  issues  vital  to  their  practices. 
Physicians,  board  members  and 
officers  of  the  AMA  will  come 
together  to  reach  common 
ground. 

Voice  your  concerns 

about  the  coming  changes.  Do 
not  wait  passively  for  those 
changes  to  be  imposed  without 
your  input.  The  Physicians' 
Forum  is  the  time  and  place  to 
speak  out  and  make  an  impact. 

Your  attendence  is 
crucial.  Call  toll  free  800 
621-8335.  Conference  fee  for 
meeting  facilities  and  food 
service — AMA  members  $50, 
nonmembers  $125.  MasterCard, 
VISA,  American  Express, 
Optima  are  accepted. 


American  Medical  Association 

Physicians  dedicated  to  the  health  of  America 


Colorado  Medicine  for  November,  1993 


394 


Choosing 
the  Right 
Professional 
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Shouldn’t 
Be  Hit 
or  Miss 


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with  a proven  record  of  strength, 
performance  and  experience.  The 
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We  are  rated  “A+  ” (Superior)  by 
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The  Doctors’  Company  is  the 
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insurance  company  owned  by  its 
members.  We  are  the  endorsed 
carrier  for  the  Denver  Medical 
Society. 

We  provide  outstanding  claims 
defense,  using  Colorado  counsel.  No 
claim  is  settled  without  the  consent 
of  the  doctor. 

So  don’t  miss  the  mark,  call  for 
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The  Doctors'  Company 


Professional  Liability  Insurance 


For  local  agency  referral  call 
the  Sales  Department  at 
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resident's 


Letter 


There's  a lot  of  truth  in 
what  Mark  Twain  said: 

" Always  do  right  This 
will  gratify  some  people, 
and  astonish  the  rest". 

But  I'm  wondering  how 
this  might  apply  to  the 
Clinton  Administration's 
so-called  Health  Care 
Plan.  On  the  face  of  it,  the 
"Plan"  sounds  right , but  it 
may  well  be  just  another 
political  euphemism. 

To  paraphrase  one 
journalist , the  secret  is  to 
get  a program  accepted  in 
terms  of  goals  that  are 
unassailable , make  it  a 
sacred  cow , and  then 
worry  about  how  to  pay 
for  it. 

Shortly  after  the  CMS  Annual 
Meeting,  a number  of  Colorado 
physicians  attended  the  AMA 
political  education  conference  held 
in  Washington,  D.  C.,  right  on  the 
heels  of  President  Clinton's  now- 
famous  health  care  reform  speech.  It 
was  an  incredible  opportunity.  We 
heard  addresses  by  several  outstand- 
ing political  figures  from  both 


parties.  (Incidentally,  I heard  no  boos 
or  hisses  when  Donna  Shalala  spoke, 
contrary  to  a New  York  Times  article 
carried  by  a Denver  paper.)  The 
speakers  were  animated  and  the 
discussion  very  lively. 

We  were  also  able  to  visit  most 
of  the  Colorado  Congressional 
Delegation,  providing  us  with  an 
opportunity  for  a unique  behind-the- 
scenes  look  at  the  legislative  process. 
We  had  meaningful  discussions  with 
our  legislators,  all  of  whom  were 
open  and  helpful.  In  fact,  I think  they 
were  glad  to  see  us  and  appreciate 
our  input.  We  made  at  least  two 
suggestions  which  I am  confident 
will  appear  as  legislative  proposals  in 
the  coming  health  care  reform 
debate.  They  concern  tort  reform  and 
anti-trust  relief  for  physicians  (and 
not  just  hospitals). 

We've  all  been  occupied  a lot  by 
the  Clinton  Health  Care  Plan  since 
its  announcement.  We  have  invested 
considerable  CMS  staff  and  personal 
time,  just  like  many  politicians  and 
the  insurance  industry,  in  particular, 
trying  to  get  a handle  on  the  "Plan", 
but  the  real  plan  still  evades  us. 

When  we  left  Washington,  we  came 
away  with  a number  of  impressions. 
For  example,  there  is  respect  among 
Washington  politicians  for  the 
consummate  speaking  and  debating 
skills  of  the  Clintons,  verging  on 
many  people  holding  them  in  awe. 
No  one  can  quarrel  with  the  Presi- 
dent's stated  goals  of  security, 
simplicity,  savings,  choice,  quality 
and  responsibility.  But  there's  also  a 
seductiveness  in  the  assertion  that 
the  Clinton  Plan,  with  all  its  laudable 


goals,  does  provide  the  means  to 
achieve  these  goals.  The  Clintons  are 
widely  credited  with  bringing  the 
health  care  issue  to  the  forefront  of 
the  American  political  conscious- 
ness; however,  lawmakers  on  both 
sides  of  the  aisle  are  clearly  divided 
between  support  and  opposition  of 
the  "plan".  As  I see  it,  I anticipate  the 
unveiling,  by  Democrats  and  Repub- 
licans, of  a number  of  alternative 
proposals.  Whatever  they  are,  all 
physicians  should  educate  them- 
selves in  preparation  for  this  debate. 
Our  patients  have  as  much  at  stake 
on  the  outcome  as  we  do,  and 
patients  will  be  coming  to  us  for 
advice  and  opinion.  The  political 
advice  we  provide  them  may 
ultimately  be  nearly  as  important 
over  their  lifetimes  as  our  specific 
medical  advice.  The  issues  are  too 
important  for  us  to  tolerate  those 
who  deal  in  self-serving  politics  and 
propaganda,  whether  they  are 
politicians,  health  care  providers  of 
whatever  stripe,  or  anyone  else  with 
a vested  interest. 

Going  back  to  something  with  a 
tremendously  positive  ring,  our 
1 23rd  Annual  Meeting  was  (by  the 
time  you  receive  this)  now  nearly 
two  months  ago  , but  it  is  still  very 
fresh  in  my  mind  because  of  many 
pluses.  First,  attendance  was  high, 
and  thanks  to  our  CMS  staff  and  the 
management  of  Snowmass  Resort,  it 
was  a superb  meeting.  Second,  there 
is  a new  spirit  abroad  in  Colorado 
medicine.  There  was  an  intensity  and 
a sense  of  purpose  about  this  Annual 
Meeting  that  we've  not  seen  in  many 


396 


Colorado  Medicine  for  November,  1993 


years.  It's  hard  to  describe;  people 
who  had  never  attended  such  a 
meeting  were  thrilled  and  excited. 
They  had  no  idea  what  to  expect 
when  they  came,  and  they  returned 
to  their  component  societies  with  a 
new  sense  of  the  value  and  rel- 
evancy of  our  organization.  Third, 
the  Board  of  Directors  and  the  House 
of  Delegates  functioned  proactively 
and  with  integrity.  Responses  from 
members  of  the  Board,  comments 
and  debate  from  the  floor  of  the 
House,  all  were  succinct  and 
carefully  reasoned.  The  salient 
outcome  of  the  meeting  was  an 
endorsement  of  the  general  spirit  of 
the  goals  expressed  at  the  Strategic 
Planning  Retreat  held  in  Fort  Collins. 
These  goals,  while  forward-looking, 
are  at  the  same  time  consonant  with 
our  history  and  tradition. 

The  Annual  Meeting  was  notable 
for  another  highly  unusual  and 
probably  significant  event.  For  the 
first  time  in  my  memory,  there  were 
three  candidates,  each  of  them 
outstanding  , for  office  of  the  Presi- 
dent-elect. It  was  a spirited  election, 
as  has  been  described  in  a previous 
Colorado  Medicine  issue.  The 
society  is  indeed  fortunate  to  have  so 
many  talented  and  capable  people 
who,  at  such  a critical  moment  in 
our  history,  are  willing  to  undertake 
the  responsibility  and  considerable 
personal  sacrifice  to  assume  this 
leadership  role.  To  me,  this  attests  to 
the  renewed  vigor  in  our  Society  and 
the  realization  that  the  decisions  we 
make  in  the  next  few  months  and 
years  are  vital  to  the  citizens  of 
Colorado  and  to  the  preservation  of 


our  honored  profession.  To  all  the 
candidates,  and  particularly  to  David 
Martz,  the  winner,  my  sincerest 
congratulations! 

Not  long  after  our  Annual 
Meeting,  Leigh  Truitt  and  I were 
privileged  to  participate  in  a panel 
discussion  at  the  annual  meeting  of 
the  HMO  Association  of  Colorado.  It 
was  an  excellent  and  informative 
two-day  meeting.  Attending  were 
representatives  of  all  of  Colorado's 
major  health  insurance  players  as 
well  as  experts  from  Washington, 
D.C.  and  elsewhere  in  health  policy, 
law,  and  economics  . It  was  helpful 
for  us  to  come  to  a clearer  under- 
standing of  the  viewpoint  of  these 
experts.  Hopefully  Leigh  and  I were 
able  to  provide  them  with  a measure 
of  understanding  of  our  feelings  and 
concerns.  I appreciated  the  courtesy 
and  hospitality  of  the  HMO  Associa- 
tion . 

Under  our  reorganization 
mandate,  the  task  will  be  to  stream- 
line the  Society  and,  hopefully,  make 
it  more  productive.  We  must  cope 
with  the  fact  that  our  resources  are 
limited,  unless  we  elect  to  raise  our 
dues.  We  are  considering  various 
ways  to  stretch  our  dues  base, 
reduce  expenditures  and  develop 
non-dues  revenues  by  activities 
which  legitimately  serve  the  needs  of 
the  membership.  All  this  must  be 
done  in  a new  environment  where 
far  more  time,  effort,  skills  and 
money  are  required  to  meet  the  new 
challenges  confronting  us.. 

Work  toward  reorganization  of 
Councils  and  Committees  continues, 
while  we  are  also  striving  to  priori- 
tize activities  as  rapidly  as  possible. 


I urge  and  encourage  everyone 
to  participate  by  volunteering  for 
vital  committee  work,  recruiting  new 
members,  communicating  your 
concerns  to  staff,  and  by  contributing 
articles  and  cogent  letters  to  the 
editor  of  Colorado  Medicine. 

And  so  we  will 
continue  to >,  as  Mark 
Twain  said , strive  to 
"Always  do  right".  No 
doubt , our  efforts  will 
gratify  some  people , and 
astonish  the  rest. 

I'm  not  sure  Mark 
Twain  always  did 
everything  right  either. 
There  is  the  story  that  he 
was  run  out  of  Virginia 
City , Nevada , when  he 
challenged  a fellow  writer 
to  a duel. 


Colorado  Medicine  for  November,  1993 


397 


XECUTI  VE 


Director's 


Update 


Sandra  L.  Maloney 
Executive  Director 
Colorado  Medical  Society 


" ...  waltzing  with  gorillas!" 

In  September,  I attended  the 
three-day  semi-annual  State  CEO 
Conference  of  the  American  Associa- 
tion of  Medical  Society  Executives 
(AAMSE)  in  Jackson  Hole,  Wyoming. 
In  attendance  were  the  chief  execu- 
tive officers  from  about  50%  of  the 
state  medical  societies.  Compared  to 
other  meetings,  this  is  one  of  the 
most  valuable.  It's  a great  opportu- 
nity to  gather  with  my  brethren  and 
gather  a lot  of  valuable  information; 
the  support  from  these  guys  is  great. 
(Yes,  it  is  literally  "the  guys",  as  I was 
the  only  female  CEO  in  attendance. 
Karen  Meyer,  the  CEO  from  Ver- 
mont, was  unable  to  attend.) 


During  this  session,  we  dis- 
cussed health  system  reform  and 
related  issues,  malpractice  insurance 
issues,  organizational  and  adminis- 
trative issues,  just  to  name  a few  of 
the  agenda  items.  I'll  report  on 
highlights  of  these  lively  discussions. 

For  obvious  reasons,  health 
system  reform  was  foremost  in 
everyone's  mind.  Discussion  cen- 
tered around  how  state  medical 
societies  should  change  in  order  to 
keep  step  with  the  needs  of  mem- 
bers. We  all  tried  to  answer  the 
question  of  what  is  the  further  of 
your  state  medical  society? 

A lot  of  time  was  spent  on  the 
development  of  statewide  physician 
networks.  Practically  every  state  in 
the  nation  is  creating  these  networks. 
Yes,  they  are  taking  varying  forms, 
but  the  concept  is  the  same. 

Several  of  the  participants 
reported  on  their  relationship  with 
their  state  hospital  association  . 

There  are  some  states  where  these 
two  groups  work  very  closely 
together  on  various  issues.  This  is  not 
necessarily  so  in  Colorado.  Perhaps 
CMS  should  evaluate  its  relationship 
to  the  Colorado  Hospital  Associa- 
tion. 

With  respect  to  malpractice 
insurance,  I was  delighted  to  hear 
that  no-fault  insurance  is  being 
discussed  in  other  states.  Copic  is  to 
be  commended  for  having  such  a 
fine  reputation  outside  of  Colorado. 
For  this  we  owe  K.  Mason  Howard, 
MD,  a debt  of  gratitude. 

Most  states  reported  that  mem- 
bership was  up,  and  that  is  also  true 
in  Colorado.  We  all  felt  that  the 
threat  of  health  system  reform  is 
bringing  in  new  members.  Interest- 


ingly enough,  most  states  (except 
Colorado)  have  increased  their  dues 
consistently  over  the  past  years.  One 
state  increases  its  dues  annually  to  at 
least  match  the  consumer  price 
index.  Interesting  concept. 

A lot  of  time  was  spent  discuss- 
ing the  relationship  between  county, 
state  and  national  medical  and 
specialty  organizations.  Most  state 
medical  societies  have  a person  who 
actually  staffs  specialty  societies. 
(Something  that  CMS  did  about  1 0 
years  ago.)  This  is  a valuable  service 
and  one  that,  if  the  opportunity 
arises,  CMS  should  again  consider 
offering. 

With  respect  to  county  - state 
relations,  it  is  apparent  that  Colorado 
is  very  fortunate.  I heard  some  horror 
stories  from  other  states.  Some 
reference  was  made  to  waltzing  with 
gorillas!  Yes,  on  any  given  day,  CMS 
and  a county  society  may  disagree 
on  an  issue;  however,  the  matter  is 
resolved  and  we  move  on.  Not  true 
in  other  states.  My  thanks  to  our 
county  executives  for  making  this 
relationship  work. 

I'll  not  bore  you  with  all  the 
discussion  regarding  administrative 
issues.  I will  however,  let  you  know 
that  in  comparison,  the  Colorado 
Medical  Society  has  one  of  the 
leanest  employee  benefit  packages. 
Most  states  offer  a bonus  program,  as 
well  as  several  other  "perks"  not 
offered  by  CMS. 

Following  the  meeting  I drove 
from  Jackson  Hole  to  Billings, 
Montana  to  meet  my  brother.  He 
lives  on  a ranch  about  60  miles  east 
of  Billings.  I spent  three  days  on  his 
ranch  —going  back  to  my  roots  —and 
had  a wonderful  time.  I rode,  and 


398 


Colorado  Medicine  for  November,  1993 


rode,  and  rode  his  quarter  horses.  (I 
had  muscles  hurting  where  I didn't 
realize  I had  muscles!)  The  rest  of  the 
time,  my  brother  worked  my  tail  off. 
Some  things  never  change.  I didn't 
think  about  health  care  reform, 
physicians,  legislators,  or  anything 
else  related  to  CMS.  No  offense,  but 
it  was  very  refreshing.  Somehow,  I 
think  we  get  so  involved  and  so 
close  to  our  work  environment  that 
we  can  no  longer  think  straight  — nor 
can  we  think  of  anything  else.  I again 


realized  that  it's  all  right  to  take 
things  a little  slower.  It  was  this  same 
brother  who  told  me  to  apply  for  the 
job  of  executive  director  of  CMS.  In 
his  words,  "You  have  to  try".  I repeat 
these  same  words  to  CMS  staff  and 
others.  Guess  it  is  a pretty  good 
motto. 

In  today's  violent  world,  please 
take  time  to  go  "home"  more  often. 
Never  lose  sight  of  what  brought  you 
to  where  you  are  today. 

C/M 


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You  didn’t 
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order  to 
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bib 

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Collecting  money  from 
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to  become  a bill  collector. 

And  that’s  where  I.C. 
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First  of  all,  we  have  the 
resources  and  expertise  to  do 
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courtesy  and  respect. 

In  fact,  our  work  is  en- 
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Colorado  Medicine  for  November,  1993 


399 


omen's  Health: 

A Washington,  D.  C.  perspective 


In  the  next  year  the 
US.  health  care  system 
will  undergo  a transforma- 
tion as  the  Clinton  admin- 
istration moves  toward  a 
national  health  care  plan. 

Equally  significant  will 
be  changes  in  the  area  of 
women's  health , with  the 
Congressional  Caucus  for 
Women's  Issues  pushing 
for  equity  in  women 's 
health  research  and  ser- 
vices. 


Rep.  Patricia  Schroeder  is  the  co-chair  of  the 
Congressional  Caucus  for  Women's  Issues. 
She  represents  the  First  District  of  Colorado. 


For  decades  women  have 
suspected  that  they  received  second 
rate  health  care.  However,  it  wasn't 
until  1 989  — when  the  Caucus  had 
the  General  Accounting  Office 
(GAO)  investigate  how  the  National 
Institutes  of  Health  (NIH)  treated 
women's  health  — that  we  clearly 
saw  the  differences  between  how 
men  and  women's  health  are  treated 
in  both  the  public  and  private 
sectors. 

In  their  investigation  of  NIH,  the 
GAO  reported  that  women  were 
systematically  excluded  from 
medical  research  studies,  received 
less  aggressive  treatment  than  men 
for  heart  disease  and  other  serious 
conditions,  and  lacked  access  to 
important  preventive  services. 

For  the  Caucus  these  findings 
were  a call  to  action.  Now  the 
women  of  Congress  had  the  proof 
they  needed  to  start  changing 
policies  --  from  the  halls  of  NIH  to 
the  lecture  halls  of  the  nation's 
medical  schools  to  the  examination 
rooms  of  physicians. 

The  Caucus  introduced  the 
Women's  Health  Equity  Act  (WHEA), 
a package  of  bills  setting  out  a broad 
agenda  for  improving  health  care 
research  and  services  for  women. 
WHEA  addresses  issues  ranging  from 
AIDS  research  and  prevention  to 
environmental  risk-assessment 
policies;  expanded  testing  of  gender 
differences  in  drug  trials;  and 
increased  funding  for  gender-specific 
cancers,  heart  disease,  osteoporosis, 
infertility  and  contraception  research 
and  services. 

Like  any  omnibus  packages, 
some  bills  from  WHEA  have  moved 
more  quickly  than  others.  In  the  past 


two  years  we  have  passed  several 
important  pieces  of  legislation 
including: 

• requiring  NIH  to  include  women 
in  clinical  trials; 

• creating  federal  mammography 
quality  standards; 

• setting  up  and  funding  an  Office 
of  Women's  Health  Research 
within  NIH; 

• and  increasing  research  dollars 
for  breast  and  ovarian  cancer, 
endometriosis,  fibroid  tumors, 
heart  disease,  osteoporosis, 
infertility  and  contraception. 

While  working  on  WHEA  has 
provided  many  gains,  the  Caucus  is 
still  facing  a battle  with  how  national 
health  care  reform  treats  women's 
health.  The  Clinton  administration's 
plan  leaves  us  with  several  unan- 
swered questions.  For  example:  Will 
comprehensive  reproductive  health 
care  be  covered?  How  often  will 
women  be  reimbursed  for  pap 
smears  and  pelvic  examinations? 
How  will  the  plan  ultimately  address 
the  currently  undefined  areas  of 
family  planning,  pregnancy-related 
services,  contraception  and  infertil- 
ity? Will  women  be  able  to  exercise 
their  freedom  of  choice,  regardless  of 
their  income  level? 

The  administration's  plan  also  fails  to 
adequately  cover  other  important 
preventive  measures  for  women: 

• The  plan  provides  for  screening 
mammographies  every  other  year 
for  women  over  50  years  of  age. 
Both  the  National  Cancer 
Institute  and  the  American 
Cancer  Society  recommend  them 
every  year  for  women  over  50. 


400 


Colorado  Medicine  for  November,  1993 


U.S.  Representative,  First  Congressional  District 

Denver,  Colorado 


• The  plan  fails  to  spell  out  provi- 
sions for  risk-assessment  and 
counseling  for  osteoporosis. 

Overall,  however  the  Clinton 
plan  is  a bold  first  step.  It  ensures 
that  every  American  has  health  care 
throughout  their  lives  regardless  of 
where  they  work,  where  they  live, 
how  much  they  earn,  or  pre-existing 
conditions.  It  increases  incentives  for 
going  into  primary  care  such  as  loan- 
forgiveness  programs  and  retraining, 
helping  to  fill  the  gap  in  medically 
underserved  rural  and  inner-city 


communities.  It  expands  successful 
community  and  migrant  health  care 
centers  and  school-based  clinics. 
And  it  places  a heavy  emphasis  on 
preventive  care  for  mothers  and 
children  and  covers  prescription 
drugs  and  long-term  care  so  critical 
for  our  older  Americans. 

The  Congressional  Caucus  for 
Women's  Issues  will  continue  to 
monitor  these  important  women's 
health  issues  to  ensure  that  women 
get  the  equity  they  deserve  and  the 
health  care  they  need. 


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Colorado  Medicine  for  November,  1993 


401 


ook  Review 

"The  Forgotten  Plague" 

by  Frank  Ryan,  M.D. 

Little,  Brown  and  Company,  1992 


by  Thomas  H.  Coleman,  M.D. 

Denver,  Colorado 


This  is  a detective  story 
about  scientists  who  spent 
half  the  twentieth  century 
trying  to  kill  a pale  germ 
that  has  crippled  and 
devoured  billions  of 
people  for  thousands  of 
years , at  least  since  the 
Stone  Age. 

The  doctors  of  Europe 
saw  the  slaughters  of  the 
first  World  War,  survived 
to  see  tuberculosis  killing 
more  people  than  were 
killed  in  action,  and 
continuing  to  kill  five 
million  every  year.  Those 
men  fled  to  join  the  great 
laboratories  and 
universities  of  America, 
obsessed  with  finding  the 
cure.  Some  of  them  lost 
their  wives  and  friends 
and  their  own  health  to 
the  sinister  little  microbe 
they  saw  gathered  at  the 
other  end  of  their 
microscopes. 


The  antibiotics  and  chemicals 
that  eventually  stopped  this  myco- 
bacterium were  cultured  from  molds 
in  the  soil  or  synthesized  in  the 
glassware  of  chemical  companies, 
but  they  originated  in  the  minds  and 
laboratories  of  these  remarkable 
researchers,  a fragile  network  of 
colleagues  that  spread  over  the 
Western  world  like  the  very  mycelia 
growing  in  their  Petri  dishes. 

You  may  remember  that  Robert 
Koch  identified  the  tubercle  bacillus 
as  the  cause  of  tuberculosis  (1 882). 
When  he  presented  his  evidence  he 
gave  credit  to  J.  A.  Villermin,  a 
doctor  of  the  French  Army,  whom 
nobody  might  remember  except  that 
he  had  already  shown,  twenty  years 
before,  that  the  disease  was  infec- 
tious. It  was  Koch's  laborious  search 
and  his  chance  discovery  of  the  new 
stain  that  lit  up  the  germ,  previously 
hidden  from  view  in  every  micro- 
scope. You  may  more  likely  remem- 
ber that  Selman  Waksman,  a soil 
mycologist,  collected  the  Nobel 
Prize  (1  952)  for  having  discovered 
streptomycin  as  a "cure".  But  who 
was  Albert  Schatz?  A genius  working 
in  Dr.  Waksman's  laboratory  for  $40 
a month.  Schatz  and  his  fiancee'  fell 
in  love  because  of  their  mutual 
fascination  with  slime  molds.  Schatz 
took  along  his  plates  of  actinomyces 
cultures  on  their  honeymoon.  Don't 
laugh.  FH is  long  hours  in  a cellar 
laboratory  led  the  world,  and  Dr. 
Waksman,  to  streptomycin. 

This  is  a fascinating  story  of  the 
Europeans  and  the  Americans 
working  together,  with  the  help  of 
the  Mayos,  George  Merck,  Domagk 
and  the  Bayer  Pharmaceutical 
Laboratories  in  Germany,  Hoffman- 


LaRoche  in  New  Jersey,  Dr.  Jorgen 
Lehmann  of  Gothenburg,  Karl- 
Gustav  Rosdahl,  chemist  at  the 
Ferrosan  Labs  in  Sweden.  The  names 
of  Phillip  Klee,  a German  Internist, 
William  Feldman,  veterinarian  with 
the  Mayo  Clinic,  Rene'  Dubos  at 
Harvard  and  the  Rockefeller  Univer- 
sity, were  all  in  the  roll  call  of  this 
research  force.  After  four  years  of  his 
own  research  and  interviews  with 
those  men  still  living,  Dr.  Ryan 
makes  them  all  heroes  in  their 
striving,  all  human  in  their  failures 
and  jealousies. 

A few  revelations:  Laboratories 
kept  their  discoveries  secret  until 
they  heard  rumors  that  a rival  lab 
was  about  to  announce  the  same 
ones.  The  second  World  War  kept  a 
Swedish  investigator  from  knowing 
that  he  and  the  workers  in  America 
were  making  the  same  discoveries 
about  aspirin  and  PAS.  Important 
discoveries  were  ridiculed  by  other 
doctors  who  said  they  would  never 
work.  Effective  drugs  were  rejected 
by  the  owners  of  TB  sanatoriums 
until  their  dying  patients  wrote 
personally  to  researchers,  pleading 
for  drugs  to  be  sent  direct.  After  the 
War  Production  Board  put  Dr.  H. 
Corwin  Hinshaw  in  charge  of 
rationing  streptomycin  he  was 
amazed  to  see  the  wife  of  a U.  S. 
President  use  her  influence  to  divert 
an  important  patient's  supply  to  an 
important  friend  of  hers.  Doctors 
snubbed  each  other  and  argued  over 
who  deserved  the  royalties  they 
considered  legitimate  rewards  for 
their  work. 

When  in  spite  of  disappoint- 
ments and  failures  the  doctors  did 
produce  drugs  that  actually  cured 


402 


Colorado  Medicine  for  November,  1993 


"The  Forgotten  Plague" 

(Continued) 


people  of  TB,  they  and  their  world  of 
patients  enjoyed  a euphoric  relief 
that  the  war  against  tuberculosis  had 
been  won.  There  is  dramatic  irony  in 
those  victories,  knowing  as  we  read 
about  them  now  that  their  war  was 
not  won  after  all.  The  enemy  had 
only  retreated  to  rearrange  its  DNA 
into  a new  shield  against  our  best 
weapons.  It  is  mounting  a new 
global  attack.  Are  patients  with 
tuberculosis  to  be  pushed  back 
nearly  sixty  years  into  the  world  of 
sanatoriums,  fresh  air,  sunshine  and 
a life  of  quarantine  that  was  never 
scientifically  proven  to  influence 
their  survival? 

Dr.  Ryan's  book  has  a crucial 
message.  Today's  scientists,  with  the 
same  intuition  and  ingenuity  that 
drove  their  teachers  to  what  they 


thought  was  victory,  will  have  to 
discover  and  produce  new  drugs, 
and  they  had  better  hurry  up.  There 
are  now  at  least  20  million  people  in 
the  world  infected  with  HIV  and 
AIDS,  especially  vulnerable  to 
tuberculosis.  The  medical  profession 
has  assured  the  world  that  HIV  itself 
is  not  contagious  without  intimate 
contact.  Now  all  people  with 
depressed  immunity,  not  only  those 
with  HIV,  but  the  old,  the  homeless, 
the  young,  the  malnourished,  are 
potential  carriers  of  a new  drug- 
resistant  tuberculosis.  They  will  be 
contagious  for  all  of  us,  healthy  or 
not,  merely  through  careless  cough- 
ing across  a supper  table,  in  a 
crowded  bus,  in  a business  meeting, 
in  a children's  classroom.  So  far, 
there  is  no  protection  at  any  level  of 
human  society.  A pandemic  would 
outrun  HIV.  A new  generation  of 
medical  scientists  may  eventually 
solve  the  problem.  That  story  will  be 
an  even  greater  epic. 


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Colorado  Medicine  for  November,  1993 


403 


Frederick  A.  Lewis,  Jr.,  M.D.,  Chair 
Council  on  Legislation 


Lobby 


Is  there  life  after  Health  Care  Reform? 


This  article  was  being 
written  about  2 weeks 
after  President  Clinton's 
speech  on  Health  Care 
Reform  (HCR)  was  deliv- 
ered on  September  22, 

1 993.  Since  that  time  the 
nation  has  been  bom- 
barded with  little  else. 

One  assumes  that  this 
will  continue  over  the  next 
year,  although  perhaps  at 
a decreased  decibel  level. 
A delegation  from  CMS 
attended  the  AMA  politi- 
cal Education  Conference 
in  Washington  and  this  is 
a report  to  the  member- 
ship about  some  of  the 
things  we  learned. 


The  media  iri  general  is  attempt- 
ing to  characterize  the  current 
debate  as  the  medical  profession 
(AMA)  vs.  Clinton's  proposal.  This 
may  sell  newspapers  but  is  simply 
not  accurate.  The  facts  are  that  the 
AMA  has  supported  HCR  since 
1 990.  Both  the  AMA  and  CMS  are 
in  favor  of  many  of  the  concepts 
outlined  in  Clinton's  plan.  In 
addition,  there  are  seven  other  HCR 
proposals  which  have  been  or  will 
be  introduced  in  Congress.  Many  of 
these  contain  concepts  similar  to  the 
administration's  proposal.  Physicians 
should  not  allow  themselves  to  be 
pushed  into  an  up  or  down  vote  on 
Clinton's  proposal.  We  have  to  be 
selective  about  which  concepts  we 
favor  and  which  we  oppose.  In 
order  to  do  this,  we  have  to  be 
knowledgeable  about  the  specifics  of 
the  plan. 

The  "spin"  is  important.  We 
cannot  allow  the  debate  to  be 
portrayed  as  "greedy  doctors  at- 
tempting to  preserve  the  status  quo 
in  order  to  gouge  unsuspecting 
patients".  Instead,  we  need  to 
structure  the  debate  as  "physicians 
attempting  to  protect  their  patients 
from  having  their  health  care  cut  by 
power  hungry  bureaucrats".  More 
specifically,  physicians  have  no 
difficulty  in  endorsing  Clinton's  six 
principles,  i.e.  security,  savings, 
quality,  simplicity,  choice,  and 
responsibility.  However,  Clinton's 
program  seems  to  suggest  that  you 
can  increase  access  and  quality 
while  cutting  cost.  This  has  tremen- 
dous sales  appeal  but  is  simply  not 
feasible  in  the  real  world. 

In  an  effort  to  protect  our 


patients,  we  are  an  advocate  for: 

1.  Universal  coverage. 

2.  Standard  benefit  package  for 
everyone. 

3.  Uniform  claim  form  and  bureau- 
cratic simplification. 

4.  Insurance  reforms  including  no 
pre-existing  conditions. 

5.  Relative  state  autonomy  in 
structuring  local  programs.. 

6.  Emphasis  on  improving  quality. 

According  to  some  estimates,  it 
will  take  $441  billion  to  fund 
Clinton's  health  care  plan.  In  our 
role  as  the  patient's  advocate,  we 
have  serious  reservations  about: 

1.  Funding  mechanisms  which  rely 
upon: 

a.  Cutting  Medicare  and  Medic- 
aid benefits  by  $188  billion. 
(This  can  not  be  good  for 
patients.) 

b.  Cutting  waste,  fraud,  and 
abuse  in  the  current  system. 
(Laudable  goals  but  unlikely  to 
generate  $1  30  billion.) 

c.  Tax  on  cigarettes  - $70  billion 
over  five  years.  Fine  but 
hardly  sufficient  to  fund 
meaningful  HCR.  d.  Deficit 
financing  - not  good  for  the 
country. 

2.  Insurance  premiums  capped  at 
rise  in  CPI  plus  rise  in  population. 
Sounds  OK  but  grossly  inad- 
equate in  terms  of  recent  histori- 
cal experience.  It  seems  highly 
unlikely  that  this  goal  can  be  met 
unless  the  AHP  forces  providers 
to  cut  services.  If  this,  in  turn, 
does  not  succeed,  fall  back 
bureaucratic  controls  are  insti- 
tuted, global  budgeting  becomes 


404 


Colorado  Medicine  for  November,  1993 


"...  life  after  HCR?" 

(Continued) 

operative  and  the  entire  health  care 
system  can  be  taken  over  by  the 
federal  government.  The  only 
remaining  option  at  that  point 
would  be  rigorous  rationing  of 
health  care.  We  do  not  consider 
any  of  this  to  be  in  the  best 
interests  of  our  patients. 

3.  Inadequate  tort  reform  proposals. 
- Clinton's  plan  does  not  contain  a 
cap  on  non-economic  damages 
and/or  meaningful  limits  on 
contingency  fees,  both  of  which 
are  necessary  for  serious  malprac- 
tice reform. 

4.  Inadequate  modification  of  anti- 
trust legislation  in  regard  to 
physicians.  Clinton's  proposal 
would  limit  any  physician-run 
plan  to  a market  penetration  of 
20%.  No  such  limits  are  imposed 
on  insurance  companies  or 
hospital  driven  plans.  Polls 
indicate  that  patients  prefer  their 
own  physician  to  an  HMO.  Both 
patients  and  physicians  deserve  a 
level  playing  field. 

5.  Clinton's  plan  proposes  preserva- 
tion of  fee  for  service  medicine,  as 
promised  in  big  speech.  How- 
ever, the  plan  states  that  this 
option  is  at  increased  cost  to  the 
patient,  includes  a fixed  fee 
schedule  and  no  balance  billing. 

It  also  contains  a clause  which 
allows  the  AHP  to  abolish  this 
option  if  it  proves  "economically 
unfeasible".  All  of  this  would 
appear  to  be  unfair  to  our  patients 
and  may  result  in  the  fee  for 
service  option  being  unavailable 
or  available  only  to  the  rich. 

At  this  point,  physicians  do  not 
have  to  be  forceful  supporters  of  or 
opposers  to  Clinton's  HCR  proposal. 
However,  we  do  have  to  do  our  best 
to  educate  the  public  about  the 
specifics  of  these  very  complicated 
issues.  If  we  can  do  this  successfully, 
we  can  be  assured  that  the  public 
will  make  the  decisions  which  are  in 
their  best  interests. 

In  response  to  the  title  of  this 
article,  the  answer  is  "maybe". 


Large  Colorado  Medical  Society  physician  delegation 
goes  to  Washington,  D.  C. 

AMA  provides  political  education  conference 


The  AMA  held  its  National 
Political  Education  Conference 
September  29th  and  30th  in  Wash- 
ington D.C.  Colorado  had  12 
I representatives  at  the  conference. 
Participants  included:  Wm.  Carl 
Bailey,  MD,  CMS  President;  David 
Martz,  MD,  CMS  President-Elect; 
Frederick  A.  Lewis,  Jr.,  MD,  Council 
on  Legislation  Chairman;  Rob  Bogin, 
MD,  COMPAC  and  AMPAC  Board 
Member;  Joshi  Janak,  MD  and  his 
wife  Anjana  Janak;  Eugene  Jacobson, 
MD;  Fred  Abrams,  MD;  Diane 
Glismann,  RN,  NP,  COMPAC  Board 
Member  and  CMSA  1994  Legislative 
Chairman;  Mary  Hanson,  AMA 
Alliance  President;  Sue  Ellen  Quam, 
Director,  CMS  Department  of 
Government  Relations;  and  Lorraine 
Koehn,  Program  Manager/Lobbyist, 
CMS  Department  of  Government 


Relations.  All  of  these  participants 
should  be  thanked  for  taking  time 
from  their  busy  schedules  to  attend 
this  conference. 

One  of  the  most  important 
opportunities  Colorado's  participants 
had  while  in  Washington  D.C.  was 
the  ability  to  meet  personally  with 
Colorado's  Federal  Legislators.  The 
Colorado  Medical  Society  would  like 
to  thank  Senator  Hank  Brown, 
Jennifer  Evans  of  Senator  Ben 
Nighthorse  Campbell's  office,  Doug 
Nelson  of  Congresswoman  Pat 
Schroeder's  office,  Congressman 
David  Skaggs,  Congressman  Scott 
Mclnnis,  Congressman  Wayne 
Allard,  Congressman  Joel  Hefley  and 
Congressman  Dan  Schaefer  for 
meeting  with  Colorado  representa- 
tives to  the  AMA  National  Political 
Education  Conference.  c/m 


Attending  the  AMPAC  Political  Education  Conference  in  Washington,  DC 
were  (From  left)  CMS  President-Elect  David  C.  Martz,  MD,  CMS  Director  of 
Government  Relations  Sue  Ellen  Quam,  CMS  Alliance  Past  President  Diane 
Duffy  Glismann,  CMS  Government  Relations  Program  Manager  Lorraine 
Koehn  and  CMS  President  Wm.  Carl  Bailey,  MD. 

Addressing  the  group 
were  (left)  Senate 
Minority  Leader 
Robert  Dole  (R-KS) 
and  (right)  House 
Minority  Whip  Newt 
Gingrich  (R-GA). 


C/M 


Colorado  Medicine  for  November,  1993 


405 


Health  Care 


Policy 


More  OSHA  Questions  and  Answers 


Ellen  Stein , Director 
Marilyn  Barton , 

Program  Manager 
Lynn  Livingston , 
Administrative  Assistant 
Health  Care  Policy 
Department 


In  April,  the  first  in  an  ongoing  series 
of  OSHA  "Questions  and  Answers" 
was  featured  in  Colorado  Medicine  . 
The  material  for  this  second  article 
was  taken  from  an  OSHA  publica- 
tion entitled,  Most  Frequently  Asked 
Questions  Concerning  The  Blood- 
borne  Pathogens  Standard. 

Q.  What  type  of  disinfectant 
can  be  used  to  decontaminate 
equipment  or  working  surfaces 
which  have  come  in  contact  with 
blood  or  other  potentially  infectious 
materials  (OPIM)? 

A.  EPA  registered  tubercu- 
locidal  disinfectants  are  appropriate 
for  the  cleaning  of  blood  or  OPIM.  A 
solution  of  5.25  percent  sodium 
hypochlorite,  (household  bleach), 
diluted  between  1:10  and  1 : 1 00  with 
water,  is  also  acceptable  for  cleaning 
contaminated  surfaces. 

Quaternary  ammonium  products 
are  appropriate  for  use  in  general 
housekeeping  procedures  that  do  not 
involve  the  cleanup  of  contaminated 
items  or  surfaces. 

The  particular  disinfectant  used, 
as  well  as  the  frequency  with  which 
it  is  used,  will  depend  upon  the 
circumstances  in  which  a given 
housekeeping  task  occurs  (i.e., 
location  within  the  facility,  type  of 
surface  to  be  cleaned,  type  of  soil 
present,  and  tasks  and  procedures 
being  performed).  The  employer's 
written  schedule  for  cleaning  and 
decontamination  should  identify 
such  specifics  on  a task-by-task 
basis. 


Q.  How  should  contaminated 
laundry  be  handled? 

A.  Contaminated  laundry  shall 
be  handled  as  little  as  possible  with  a 
minimum  of  agitation.  Contaminated 
laundry  shall  be  bagged  or  contain- 
erized at  the  location  where  it  was 
used  and  shall  not  be  sorted  or 
rinsed  in  the  location  of  use.  Other 
requirements  include: 

-Contaminated  laundry  shall  be 
placed  and  transported  in  bags 
or  containers  labeled  or  color- 
coded  in  accordance  with 
paragraph  (g)(1)(i)  of  the  stan- 
dard. When  a facility  utilizes 
Universal  Precautions  in  the 
handling  of  all  soiled  laundry, 
alternative  labeling  or  color- 
coding is  sufficient  if  it  permits 
all  employees  to  recognize  the 
containers  as  requiring  compli- 
ance with  Universal  Precautions. 

-Whenever  contaminated  laundry 
is  wet  and  presents  a reasonable 
likelihood  of  soak-through  or 
leakage  from  the  bag  or  con- 
tainer, the  laundry  shall  be 
placed  and  transported  in  bags 
or  containers  which  prevent 
soak-through  and/or  leakage  of 
fluids  to  the  exterior. 

—The  employer  shall  ensure  that 
employees  who  have  contact 
with  contaminated  laundry  wear 
protective  gloves  and  other 
appropriate  personal  protective 
equipment. 

-When  a facility  which  does  not 
utilize  Universal  Precautions  in 


406 


Colorado  Medicine  for  November,  1993 


Health  Care 


P 


O L I C Y 


the  handling  of  all  laundry,  the 
facility  generating  the  contami- 
nated laundry  must  place  such 
laundry  in  bags  or  containers 
which  are  labeled  or  color- 
coded  in  accordance  with 
paragraph  (g)(1  )(i)  of  the  stan- 
dard. 

Q.  Are  employees  allowed  to 
take  their  protective  equipment 
home  and  launder  it? 

A.  Employees  are  not  permitted 
to  take  their  protective  equipment 
home  and  launder  it.  It  is  the  respon- 
sibility of  the  employer  to  provide, 
launder,  repair,  replace,  and  dispose 
of  personal  protective  equipment. 

Q.  Do  employers  have  to  buy  a 
washer  and  dryer  to  clean  employ- 
ees' personal  protective  equipment? 

A.  There  is  no  OSHA  require- 
ment stipulating  that  employers  must 
purchase  a washer  and  dryer  to 
launder  protective  clothing.  It  is  an 
option  that  employers  may  consider. 
Another  option  is  to  contract  out  the 
laundering  of  protective  clothing. 
Finally,  employers  may  choose  to 
use  disposable  personal  protective 
clothing  and  equipment. 

Q.  My  company  supplies 
contract  employees  to  health  care 
facilities.  What  are  my  responsibili- 
ties under  the  Bloodborne  Pathogens 
Standard? 

A.  OSHA  considers  personnel 
providers,  who  send  their  own 
employees  to  work  at  other  facilities, 
to  be  employers  whose  employees 
may  be  exposed  to  hazards.  Since 


your  company  maintains  a continu- 
ing relationship  with  its  employees, 
but  another  employer  (your  client) 
creates  and  controls  the  hazard, 
there  is  a shared  responsibility  for 
assuring  that  your  employees  are 
protected  from  workplace  hazards. 
The  client  employer  has  the  primary 
responsibility  for  such  protection,  but 
the  "lessor  employer"  likewise  has  a 
responsibility  under  the  Occupa- 
tional Safety  and  Health  Act.  In  the 
context  of  OSHA's  standard  on 
Bloodborne  Pathogens,  29  CFR 
1 91 0.1  030,  your  company  would  be 
required,  for  example,  to  provide  the 
general  training  outlined  in  the 
standard;  ensure  that  employees  are 
provided  with  the  required  vaccina- 
tions; and  provide  proper  follow-up 
evaluations  following  an  exposure 
incident.  Your  clients  would  be 
responsible,  for  example,  for  provid- 
ing site-specific  training  and  personal 
protective  equipment,  and  would 
have  the  primary  responsibility 
regarding  the  control  of  potential 
exposure  conditions.  The  client,  of 
course,  may  specify  what  qualifica- 
tions are  required  for  supplied 
personnel,  including  vaccination 
status.  It  is  certainly  in  the  interest  of 
the  lessor  employer  to  ensure  that  all 
steps  required  under  the  standard 
have  been  taken  by  the  client 
employer  to  ensure  a safe  and 
healthful  workplace  for  the  leased 
employees.  Toward  that  end,  your 
contracts  with  your  clients  should 
clearly  describe  the  responsibilities 
of  both  parties  in  order  to  ensure  that 
all  requirements  of  the  regulation  are 
met. 


Are  you  in  compliance 
with  the  Bloodborne 
Pathogen  Standard? 


Colorado  Medicine  for  November,  1993 


407 


Health  Care 


Policy 


M.l.  Provider 
Profiles 

Over  the  last  year  the  CMS  Commit- 
tee on  Care  of  the  Medically  Indigent 
has  heard  presentations  on  programs 
from  around  the  state  which  provide 
free  or  low  cost  medical  care  to 
people  who  have  difficulty  accessing 
such  care.  A few  of  these  programs 
are  profiled  below. 

School-Based  Clinics  - These 
were  originally  envisioned  as  a way 
to  increase  access  to  health  care 
services  for  adolescents.  There  are 
currently  school-based  clinics  in 
three  Denver  public  high  schools: 
East,  Manual  and  Lincoln.  Plans  are 
underway  to  open  additional  clinics 
in  five  elementary  schools,  one 
middle  school  and  one  high  school 
in  Montbello. 

The  three  clinics  which  are 
presently  operating  offer  both  mental 
and  physical  health  services.  Accord- 
ing to  David  Kaplan,  M.D.,  founder 
of  the  Denver  school-based  clinics, 
the  number  of  kids  seeking  help  for 
mental  health  problems  is  about 
equal  to  those  presenting  with 
physical  health  problems.  This 
generates  a need  for  more  mental 
health  services  and  staff.  Seventy-five 
percent  of  the  student  at  East, 

Manual  and  Lincoln  are  enrolled  in 
the  clinics. 

There  are  currently  counseling 
programs  available  at  the  clinics  for 
the  following  groups:  abusive  young 
men,  gay  and  lesbian  youth,  youths 
who  have  had  a parent  die,  young 
people  with  substance  abuse  prob- 
lems and  runaways. 

Dr.  Kaplan  reported  that  the  drug 


and  alcohol  treatment  program 
which  was  started  at  Lincoln  High 
School  a few  years  ago  has  been 
quite  successful.  Prior  to  the  incep- 
tion of  this  program  it  had  been  the 
policy  of  the  Denver  Public  Schools 
to  suspend  anyone  caught  selling  or 
using  drugs  or  alcohol.  Quite  often, 
those  that  were  suspended  dropped 
out  of  school.  Once  the  drug  and 
alcohol  treatment  program  was  in 
place,  kids  were  given  a choice 
between  mandatory  treatment, 
consisting  of  at  least  ten  sessions,  or 
suspension.  One  year  after  the 
program  had  been  in  effect,  the 
suspension  rate  had  decreased  by 
70%. 

The  school-based  clinics' 
governing  body,  The  Denver  School 
Health  Coordinating  Council,  is 
composed  of  representatives  from 
Denver  Health  and  Hospitals,  the 
Denver  Public  Schools,  Children's 
Hospital  and  the  Mental  Health 
Corporation.  The  Council  has 
adopted  a model  which  calls  for  the 
clinics  to  utilize  existing  school 
resources  and  staff.  The  Council  is 
also  recommending  that  school 
nursing  staffs  receive  the  additional 
training  necessary  to  become  nurse 
practitioners. 

The  Colorado  Child  Health  Plan 

- Stephen  Berman,  M.D.,  originator 
of  the  Plan,  reported  that  the  pro- 
gram provides  a full  range  of  ambu- 
latory care  to  children  under  age  1 2 
who  are  not  insured  and  not  on 
Medicaid  and  whose  families  make 
less  than  1 50%  of  the  federal  poverty 
level.  The  program  currently  extends 
to  children  who  live  in  two  pilot 
areas  of  the  state,  Northeastern 
Colorado,  including  Logan,  Morgan, 


Washington,  Kit  Carson,  Elbert, 
Lincoln,  Sedgwick,  Cheyenne  and 
Yuma  counties  and  the  Western 
Slope  counties  of  Delta,  Mesa, 
Montrose  and  Garfield.  There  is  a 
$7,500  limit  per  child  per  year 
(rather  than  exclusion  of  a condi- 
tion.) All  of  the  children  enrolled  in 
the  Child  Health  Plan  are  eligible  for 
the  medically  indigent  program 
which  is  intended  to  serve  as  a 
backup  should  a child's  health  care 
costs  exceed  $7,500.  Funding  comes 
from  state  and  private  sources  and 
from  a $25  per  year,  per  child,  $1 50 
maximum  per  family  contribution. 

Each  child  enrolled  in  the  Plan  is 
required  to  select  a primary  care 
provider  from  a list  of  participating 
physicians.  The  primary  care  pro- 
vider is  responsible  for  management 
of  the  care  for  children. 

Application  forms  are  available 
through  each  county's  social  services 
department,  county  public  health 
nurses,  the  hospitals  or  by  calling  1 - 
800-359-1991. 

The  Stout  Street  Clinic  - The 
clinic  provides  to  homeless  adults 
and  children  in  the  Denver  metro 
area  primary  health  care,  pre  and 
post  natal  care,  full  dental  services, 
mental  health  and  substance  abuse 
treatment  and  in-patient  and  medical 
specialty  services  through  a contrac- 
tual relationship  with  Denver  Health 
and  Hospitals.  Clients  seen  at  the 
clinic  are  ineligible  for  Medicaid. 

In  1 992  the  clinic  staff  saw 
5,872  individuals.  Four  hundred 
sixty  were  children  0 to  1 9 years  of 
age  who  were  accompanied  by  their 
families.  Five  hundred  fifty  were 
adults  over  the  age  of  20  who  were 
with  their  families.  One  hundred 


408 


Colorado  Medicine  for  November,  1993 


forty-three  were  runaways  or  unat- 
tached youths  and  4,1  78  were 
unattached  adults.  The  ethnic 
composition  of  the  group  of  5,872 
was  as  follows:  55%  Caucasian,  21% 
Black,  17%  Hispanic  and  7%  Native 
American. 

Clinic  staff  report  that  while 
many  of  their  patients'  medical 
conditions  are  attributable  to  their 
lack  of  stable  housing  (i.e.  trauma 
associated  with  assault,  infectious 
disease  due  to  group  living  situations 
and  infections),  other  patients  have 
found  themselves  unable  to  afford 
stable  housing  due  to  a medical 
condition.  HIV,  mental  illness, 
chronic  low  back  pain  and  disabili- 
ties not  severe  enough  to  merit 
disability  insurance  were  cited  as 
precursors  to  the  current  living 
situations  of  some  Stout  Street 
clients.  Additionally,  access  to 
available  care  and  resources  is  an 
issue  with  this  population  due  to 
educational  deficits,  language 
barriers,  lack  of  transportation  and 
mental  illness. 

Finally,  the  Stout  Street  Clinic 
has  opened  a branch  at  a public 
housing  complex  in  North  Denver  to 
serve  the  large  population  of  un- 
documented individuals  who  reside 
there.  The  clinic  was  funded  as  a 
primary  care  clinic,  however, 
according  to  Mary  Ann  Gleason, 
Stout  Street's  Executive  Director,  the 
major  portion  of  the  work  will 
consist  of  substance  abuse  and  teen 
pregnancy  counseling.  Ms.  Gleason 
additionally  reported  that  128 
children  were  vaccinated  at  an 
unadvertised  immunization  day 
recently  held  at  the  North  Denver 
Clinic. 


Health  Care 


The  Colorado  Department  of 
Health's  Migrant  Health  Program  - 

The  CDH  Migrant  Health  Program  is 
organized  into  8 catchment  areas.  In 
areas  where  there  is  a community 
health  clinic,  the  Migrant  Health 
Program  contracts  with  that  clinic  for 
primary  care  services,  including  case 
management.  Where  there  are  no 
community  health  centers,  a voucher 
system  is  used  to  reimburse  indi- 
vidual physicians  and  pharmacies. 
The  program  provides  health  care 
services  including  screenings  for 
vision  and  hearing,  TB  tests  and 
immunizations  to  23  schools  around 
the  state  . 

Don  Horton,  Director  of  the 
program,  told  members  of  the  CMS 
Committee  on  Care  of  the  Medically 
Indigent  that  twenty  thousand 
migrant  workers  come  to  Colorado 
each  year.  Approximately  51% 
migrate  from  Texas,  28%  from 
Mexico/Guatemala,  14%  from  other 
states  and  6%  from  within  Colorado. 
Ninety-eight  percent  are  Hispanic 
and  2%  are  Native  American.  Eighty 
percent  speak  Spanish  only.  The 
average  annual  family  income  is 
$6,400  for  a family  of  six.  The  CDH 
Health  Program  and  other  migrant 
health  programs  in  the  state  depend 
totally  on  federal  grant  dollars  for 
funding.  Due  primarily  to  poor 
access  to  health  care,  migrant 
children  are  twice  as  likely  as  other 
Colorado  children  to  suffer  from 
hearing  loss  and  1 0 times  as  likely  to 
be  infected  with  tuberculosis.  Also, 
due  to  limited  access,  21  % of 
Colorado's  migrant  women  do  not 
receive  prenatal  care  until  the  third 
trimester,  compared  to  5%  of  other 
Colorado  women.  Seventeen  percent 


of  migrant  women  35  and  older  have 
experienced  an  infant  death.  An 
additional  reason  that  many  migrant 
women  don't  receive  prenatal  care  is 
that  they  are  undocumented  and 
therefore  ineligible  for  such  care 
under  Medicaid.  Medicaid  does 
cover  the  delivery  as  an  emergency 
service. 

Note:  Numerous  discussions  have 
occurred  at  the  Committee  on  Care  of 
the  Medically  Indigent  regarding  how 
health  care  reform  initiatives  would 
address  the  needs  of  underserved  popu- 
lations. Those  who  provide  care  to  the 
indigent  stress  the  need  for  a system 
that  gives  priority  to  preventive  care 
and  early  intervention.  This  need  was 
poignantly  illustrated  by  an  account, 
told  to  the  Committee  by  the  director  of 
one  of  the  M.l.  clinics,  of  a homeless, 
mentally  ill  man  living  under  a bridge 
in  the  winter.  After  sustaining  severe 
frostbite,  the  man  was  admitted  to 
Denver  General  Hospital.  Subse- 
quently, both  of  his  feet  had  to  be 
amputated.  It  was  noted  that  for  the 
amount  of  money  that  it  cost  to  provide 
this  man  with  the  necessary  medical 
procedures  and  subsequent  ICU  care, 
he  could  have  been  housed  for  7 years. 


Other  Health  Care 
Policy 

The  joint  CMS/AAP  Sports  Medicine 
Committee  and  the  Colorado  High 
School  Activities  Association  have 
endorsed  the  1992  AAP  Prepartici- 
pation Physical  Evaluation  form.  The 
form  may  be  duplicated  for  use  in 
physician's  offices.  To  obtain  a form, 
call  Lynn  Livingston  or  Marilyn  Bar- 
ton at  779-5455  or  1 -800-654-5653. 


Colorado  Medicine  for  November,  1993 


409 


Health  Care  Policy 


Ellen  Stein,  Director 
Health  Care  Policy  Department 


Cardiopulmonary  Resuscitation 
(CPR)  Directives 


We  continue  to  get  calls 
on  a daily  basis  from 
patients 


We  continue  to  get  calls  on  a 
daily  basis  from  patients  asking  us  for 
CPR  Directives.  Please  note:  Patients 
cannot  get  CPR  Directives  directly 
from  CMS.  They  must  get  them  from 
their  health  care  provider. 

There  is  a lot  of  interest  in  these 
directives.  Unlike  other  advance 
directives,  which  may  be  completed 
in  full  by  the  patient  or  which  an 
attorney  may  assist  in  preparing,  the 
CPR  Advance  Directives  must  be 
signed  by  a physician.  The  form 
directs  emergency  medical  personnel 
not  to  perform  CPR  on  this  person  in 
circumstances  where  that  would 
normally  be  indicated.  The  form 
itself  is  often  maintained  in  a medi- 
cal file.  Bracelets  and  necklaces  are 
available  to  inform  ambulance 
personnel  and  others  not  to  perform 
CPR. 

In  addition,  these  forms  are 
available  to  patients  only  through 
physicians'  offices  and  licensed 
health  care  facilities  (such  as  hospi- 
tals). Please  do  not  tell  your  patients 
to  call  CMS  for  forms. 

In  the  interests  of  security  and 
informed  consent,  the  forms  are 
designed  to  be  filled  out  by  the 
patient  (or  the  patient's  designated 
representative  for  health  care 
matters)  in  consultation  with  the 
physician.  This  is  your  way  of 
guaranteeing  that  the  patient's 
interests  are  really  being  advanced. 


For  these  same  reasons,  the  forms  are 
printed  with  a custom  safety  back- 
ground that  cannot  be  easily  repro- 
duced (the  letters  "CPR"  appear  in 
the  background  in  non-photo  blue.) 
and  each  form  is  numbered.  This 
provides  tracking  and  protection  for 
both  provider  and  patient. 

There  are  two  different  kinds  of 
form,  one  for  a patient  to  fill  out 
personally  and  the  other  to  be  filled 
out  by  an  authorized  agent.  Each 
asks  for  the  information  appropriate 
to  that  use.  In  addition,  both  forms 
are  available  in  either  English  or 
Spanish. 

Physicians  and  licensed  health 
care  facilities  can  order  CPR  Direc- 
tives (patient  and/or  authorized  agent 
forms  are  available  in  English  and 
Spanish)  from  the  Colorado  Medical 
Society  by  sending  in  an  order  form 
along  with  the  appropriate  payment. 
Physicians  received  order  forms  in 
the  physician  information  packets 
sent  out  in  April. 

If  you  do  not  have  a Physician 
Information  Packet  or  need  addi- 
tional order  forms,  please  contact 
either  Marilyn  Barton  or  Ellen  Stein 
at  the  Colorado  Medical  Society 
(779-5455  or  1-800-654-5653). 

To  date,  almost  1 3,000  forms 
have  been  disseminated  to  health 
care  providers  throughout  the  state, 
(see  sample  form  on  next  page). 


410 


Colorado  Medicine  for  November,  1993 


DIRECTIVE 


Patient  Directive 

to  withhold 

Cardiopulmonary  Resuscitation  (CPR) 

State  of  Colorado 


Patient’s  Name: 


Date  of  Birth: / / Sex:  □ Male  □ Female 

Month  Day  Year 


Eye  Color: 
Hair  Color: 


Race /Ethnicity: 


□ Black,  Non-Hispanic  □ Hispanic 

□ American  Indian  or  Alaska  Native  □ White,  non-Hispanic 

□ Asian  or  Pacific  Islander  □ Other 


Name  of  hospice  program  (if  applicable) 


, 199 , pursuant  to 


am  over  the  age  of  18  years,  of  sound 


lis  directive  on  my  behalf  and  I have  been  advised  that  the  expected 
rective  is  my  death,  in  the  event  that  my  heart  or  breathing  stops  or 


I her^  ^nergency  medical  services  personnel,  health  care  providers,  and  other  persons  to 

withhrS^  ^‘ffspnimnrmry  resuscitation  in  the  event  that  my  heart  or  breathing  stops.  I under- 
stand that  this  directive  does  not  apply  to  other  medical  interventions  for  comfort  care.  If  I am 
admitted  to  a health  care  facility  this  directive  shall  be  implemented  as  a physician’s  order,  pend- 
ing further  physician’s  orders. 


Signature  of  Patient 


Signature  of  Attending  Physician 


This  form  is  a CPR  directive  authorized  by  the  Colorado  General  Assembly.  The  CPR  Directive  program  is  being  administered  by  the 
Colorado  Medical  Society  under  contract  with  the  Colorado  Department  of  Health 


Original  - Patient  (Declarant)  Yellow  - Medical  Record  Pink  - Bracelet/Necklace  Supplier 


This  form  is  not  valid  without  the  blue  "CPR"  design  in  the  background. 


ealth  care  reform  becomes 

TV  entertainment 


Rush  Limbaugh,  from  his  program  on 
syndicated  television  and  Denver's 
KWCN. 

Are  people  changing 
their  minds  about  the 
Clinton  Health  Care  Re- 
form plan? 

One  survey  indicates 
they  are. 


Rush  Limbaugh  has  been  having 
a great  time  in  recent  weeks  on  his 
radio  and  television  programs,  but 
particularly  on  television  because  the 
Clinton  Administration  has  been 
supplying  television  with  so  many 
opportunities  to  dissect  the  Clinton 
health  care  reform  message.  Leave  it 
to  Limbaugh  to  find  the  gaffs  and  the 
gaps. 

Typically,  his  television  program 
(seen  on  KMGH-TV,  Denver  at  1 1 :00 
p.m.)  started  the  health  care  reform 
segment  on  a recent  night  with  a 
specially  composed  rap  song  entitled 
"Womb  to  the  Tomb". 

Following  this,  Limbaugh 
presented  the  results  form  a recent 
Washington  Post  survey  on  the 
Clinton  Health  Care  plan.  Limbaugh 
stated  the  Post  did  a survey  shortly 
after  the  Clinton  speech  on  Septem- 
ber 22nd,  and  then  another  in  the 
second  week  of  October.  He  pre- 
sented some  of  the  latest  results.  His 
comments  follow: 


Clinton's  Health  Care  Han 

Results  of  a Washington  Post  Poll 

Q.  From  what  you  know 
of  it,  do  you  approve  or 
disapprove  of  Clinton's 
health  care  plan  ? 

Approve  51% 
Disapprove  39% 


"More  people  are  beginning  to 
be  concerned  about  this,  and  are 
willing  to  show  it.  And  the  Washing- 
ton Post  survey  shows  this. 

Right  now,  51%  approve  only 
two  weeks  to  a month  ago,  56% 
approved,  and  24%  disapproved.  A 


1 5%  increase  in  the  disapproval." 


"Health  Insurance  Costs,  56% 
say  they  will  pay  more,  and  this  is  a 
positive  sign  because  the  earlier 
surveys  were  much  higher  than  that." 


Clinton  s Health  Care  Plan 


Results  of  a Washington  Post  Poll 

Q.  Under  Clinton  s plan, 
do  you  think  the  quality 
of  the  health  care  you 
receive  will: 

Get  Better  19% 

Get  Worse  34% 

Stay  the  Same  44% 


"Health  care  you  receive  will 
19%  get  better. ...that's  right  where 
we  want  it  to  be...  that's  not  too 
many  idiots  out  there..  There's  plenty 
of  room  for  movement  on  this,  and 
the  Clinton  people  know  this. 

They're  having  all  kinds  of  trouble 
getting  this  plan  in  legislative  form, 
they're  five  weeks  away  and  I think 
they're  waiting  because  the  numbers 
don't  add  up  and  they  can't  figure 
how  to  make  'em  add  up.  Also,  this 
is  a trial-balloon,  leak  administration: 
they  float  things  out  and  get  an  idea 
what  people  will,  will  not  support." 


412 


Colorado  Medicine  for  November,  1993 


Physicians  look  to  a dim  future 

We  did  our  own  survey  among  doctors,  and  we  found  out 


A summary  of  CMS  "Physician's  Financial  Program"  1 993  survey  results 


Attitudes  among  physicians 

about  the  future  of  health  care  or  the 
national  economy  are  not  very 
optimistic.  That  was  revealed  in  a 
survey  conducted  by  Chase  Manhat- 
tan Financial  Services  of  Denver  in 
conjunction  with  the  CMS  "Phys- 
ician's Financial  Program".  The 
survey  obviously  hit  a "hot'  button 
because  there  was  an  1 1%  response 
rate,  indicating  a high  interest.  It 
asked  Colorado  Medical  Society 
members  a number  of  questions  on 
economic  matters. 

Asked  about  the  U.S.  economy 
over  the  next  5 years,  only  1 7.5%  of 
the  respondents  said  there  was  a 
positive  outlook.  Almost  40%  saw  a 
negative  future  for  the  economy  and 
over  42%  were  uncertain. 


U.  S.  Economy  under 
Clinton  Administration 
Results  of  a CMS  Survey 
of  Physicians 

What’s  your  outlook  for  the 
U.S.economy  over  next  5 years? 

Uncertain  42% 

Negative  39% 

Positive  17% 


\M  r.  ' ' / 

That's  referring  to  the  economy 
in  general.  But  regarding  the  Clinton 
Health  Care  Reform  proposal,  more 
than  81  % of  the  physicians  said  it 
would  be  damaging  to  their  medical 
practices.  Note  the  way  that  question 
was  asked.  It  wondered  whether  the 
program  would  be  helpful  or  damag- 
ing to  their  medical  practices.  That 
means  the  physicians  were  con- 
cerned with  more  than  just  eco- 
nomic factors  when  they  answered 
this  question.  The  negative  response 
indicates  that  reimbursement  is  far 


from  the  only  concern  in  health 
system  reform. 

Physicians  are  apparently  also 
worried  about  government  interfer- 
ence in  the  physician-patient  rela- 
tionship, increasing  bureaucracy  and 


Clinton’s  Health  Care  Plan 
Results  of  a CMS  Survey 
of  Physicians 

From  what  you  know  of  it, 
how  will  Clinton’s  plan 
affect  your  medical  practice? 

Damaging  to  practice  81% 
Helpful  to  practice  17% 

Uncertain  2% 


paperwork,  constraints  on  how  they 
practice  and  other  aspects  of  govern- 
ment intrusion  into  the  health  care 
relationship. 

Less  than  1 8%  of  the  respon- 
dents felt  national  health  system 
reform  was  likely  to  be  helpful  to 
their  medical  practices.  Only  a 
handful  were  uncertain.  The  vast 
majority  had  a very  dim  hope  that 
national  reform  would  improve 
health  care  delivery  in  the  U.S. 

Asked  to  choose  between  the 
national  health  system  reform 
proposal  and  a state  plan  such  as 
ColoradoCare,  respondents  generally 
favored  a state  approach.  Almost 
45%  preferred  a Colorado  plan  over 


Clinton  Plan 
vs. 

ColoradoCare 
Results  of  a CMS  Survey 
of  Physicians 

Which  plan  are  you  in  favor  of? 

National  Plan  29% 

Colorado  Plan  45% 

Other  5% 


a national  plan,  while  just  under 
30%  preferred  the  national  plan.  It  is 
worth  noting,  however,  that  almost 
22%  wrote  in  that  they  would  prefer 
neither.  It  takes  a strong  feeling  for  a 
respondent  to  move  outside  the 
boundaries  of  a survey  question  that 
way,  so  this  indicates  a significant 
pessimism  on  the  part  of  physicians 
on  this  subject. 

Another  write-in  question  was 
"How  do  you  think  passage  of  a 
health  care  reform  program  in 
Colorado  will  affect  your  medical 
practice?"  Nearly  a quarter  of  the 
respondents  indicated  that  they 
expect  more  work,  longer  hours,  less 
control,  more  interference,  more 
paperwork,  more  patients  and  less 
income.  Of  the  other  responses,  the 
vast  majority  were  negative. 

Specialists  felt  that  primary  care 
physicians  would  benefit;  primary 
care  physicians  thought  some 
specialties  would  be  better  off.  Some 
indicated  they  would  quit  medicine 
or  move  to  another  state.  Some 
indicated  uncertainty.  Of  the  few 
moderately  positive  responses,  most 
were  hopeful  that  patients,  especially 
low  income,  would  be  better  off. 
Only  two  respondents  out  of  almost 
500  could  say  something  positive 
about  their  own  practices.  One 
thought  it  would  help  a physician  in 
a poor  area,  the  other  believed  that 
reform  would  help  with  the  high 
number  of  "no-pays"  in  the  practice. 
Colorado  physicians  are  uncertain, 
frightened,  suspicious  and  pessimis- 
tic about  the  future  of  medicine  in 
the  United  States. 


Colorado  Medicine  for  November,  1993 


413 


Health  Care  Financing 


Edie  K.  Register,  Director 
Health  Care  Financing  Department 


Electronic  Claims 


Electronic  claims  processing  is 
the  wave  of  the  future,  according  to 
many  pundits  in  health  care  financ- 
ing. One  consultant  told  recently 
how  his  firm  had  expanded  into 
leasing  computer  equipment  to 
physicians'  offices  so  that  they  could 
interface  with  the  firm's  main 
computer.  The  main  computer 
downloaded  all  the  claim  informa- 
tion each  evening,  checked  it  for 
accuracy,  proper  coding,  and  other 
criteria  used  by  insurers  to  deny 
claims,  then  uploaded  the  claim  to 
the  computer  of  the  proper  insurance 
carrier. 

Many  insurance  carriers  pay 
electronic  claims  much  faster  than 
paper  claims,  and  it  is  easy  to  see 
why.  When  a claim  form  is  received 
at  the  carrier's  office,  they  must  have 
an  operator  hand  key  it  into  the 
system,  then  check  the  items  men- 
tioned above  and  either  endorse  it 


for  payment  or  kick  it  out  for  review. 
Many  times  the  review  shows  a 
clerical  error,  either  by  the  physic- 
ian's staff  or  by  their  operator.  The 
whole  process  can  take  several 
weeks. 

With  electronic  claims,  the 
computer  in  the  physician's  office  is 
programmed  with  the  CPT  codes  and 
other  information  needed  to  com- 
plete the  form.  This  information  can 
be  sent  directly  to  the  carrier.  Not 
only  is  the  processing  far  more 
simple  and  direct,  and  the  informa- 
tion much  more  accurate,  many 
carriers,  by  policy,  pay  electronic 
claims  much  faster.  They  apparently 
hope  to  motivate  physicians  to  move 
to  the  electronic  system  by  delaying 
paper  claims  as  much  as  they  are 
able. 

Colorado's  Medicare  carrier,  for 
instance,  has  instituted  a system 
called  Electronic  Media  Claims 
(EMC)  which  they  claim  is  the  "most 
efficient  claims  processing  method 
available".  They  say  EMC  claims  are 
paid  in  as  little  as  half  the  time 
required  to  handle  and  process  paper 
claims. 

EMC  can  be  used  directly  from  a 
desktop  computer;  mainframes  and 
mini-computers  are  no  longer 
required.  They  can  be  sent  over  a 
modem  or  even  on  magnetic  tape  or 
diskette.  This  carrier  even  considers 
faxed-in  claims  to  be  electronic  and 
therefore  eligible  to  be  paid  faster. 
They  hope  you  will  no  longer  be 
able  to  afford  to  submit  paper  claims. 

The  Medicare  carrier  makes 


available  free  software  for  submitting 
EMC  claims  and  also  can  supply  a 
complete  system,  additional  pro- 
gramming, or  whatever  is  needed  to 
make  your  computer  compatible 
with  their  system.  Medicare  Part  B 
claims  can  be  sent  by  FAX. 

A complete  office  automation 
system  that  is  compatible  with  EMC 
is  available  from  the  carrier  and 
handles  the  entire  patient  accounting 
process  as  well  as  appointment 
scheduling  and  management  report- 
ing. They  will  also  provide  a list  of 
vendors  whose  products  are  compat- 
ible with  their  EMC  system.  You  may 
call  them  at  831-5801  to  find  out 
more. 

One  of  the  biggest  concerns 
looming  on  the  horizon  of  electronic 
claims  processing  is  that  of  patient 
confidentiality  and  security.  If  all 
your  claims  information  is  processed 
through  someone's  computer  and 
sent  over  phone  lines,  there  is  more 
possibility  of  that  information  being 
tapped  into  by  unauthorized  persons, 
perhaps  even  an  underpaid  clerk 
who  sees  a golden  opportunity 
somewhere.  If  the  Clinton  adminis- 
tration is  successful  in  instituting  a 
uniform,  government  run  insurance 
program,  this  will  also  apply.  The 
federal  government,  in  collecting 
information  for  quality  assurance, 
payment  review,  etc.,  will  have 
exhaustive  information  about  the 
health  care  every  American  receives. 
Then  what  happens  to  the  confiden- 
tiality of  your  physician-patient 
relationship? 


414 


Colorado  Medicine  for  November,  1993 


Definitions 


The  definition  of  terms  in  health  care  financing  and  of  terms  related  to  delivery,  provision  and 
evaluation  of  care.  Colorado  Medicine  suggests  you  keep  these  monthly  articles  and  definitions, 
even  though  many  will  change,  some  will  disappear  and  new  ones  will  appear  as  the  health  system 
reform  unfolds. 


□ ADMINISTRATIVE  COSTS  -Costs 
related  to  utilization  review,  insurance 
marketing,  medical  underwriting,  agents' 
commissions,  premium  collection,  claims 
processing,  insurer  profit,  quality  assur- 
ance activities,  medical  libraries,  and  risk 
management. 

□ BASIC  BENEFITS  PACKAGE  -A  core 
set  of  health  benefits  that  everyone  in  the 
country  should  have  - either  through  their 
employers,  a government  program,  or  a 
risk  pool.  The  CMS  supports  an  affordable 
benefits  package  for  all  Americans. 

□ BENEFIT  PAYMENT  SCHEDULE- 

List  of  amounts  an  insurance  plan  will  pay 
for  covered  health  care  services. 

[_}  ERISA-The  Employee  Retirement  In- 
come Security  Act  exempts  self-insured 
health  plans  from  state  laws  governing 
health  insurance,  prohibitions  against  dis- 
ease discrimination,  and  other  state  health 
reforms. 

□ FEE  DISCLOSURES-Physicians  dis- 
cussing with  patients  their  charges  prior  to 
treatment  to  improve  cost  consciousness. 

□ GLOBAL  BUDGETS-Limits  on  cat 

egories  of  health  spending. 

[_]  HEALTH  I RAS-Proposed  tax-preferred 
plans  to  encourage  saving  for  future  medi- 
cal expenses.  Funds  in  health  IRAs  could 
be  later  cashed. 

□ INSURER  -The  party  to  an  insurance 
policy  who  contracts  to  pay  losses. 

O JOB-LOCK-The  inability  of  individu- 
alstochangejobs  because  they  would  lose 
crucial  health  benefits. 


) MANAGED  CARE-Systems  and  tech- 
niques used  by  third  party  payers  to  control 
utilization  of  health  services.  Includes  re- 
view of  medical  necessity,  incentives  to 
use  specific  providers,  and  case  manage- 
ment. 

□ MANAGED  COMPETITION-A 

health  insurance  system  that  would  band 
together  employers,  labor  groups,  and  oth- 
ers into  insurance  purchasing  groups.  Em- 
ployers and  other  collective  purchasers 
would  make  a set  contribution  toward  pur- 
chase of  insurance  for  individuals  they 
represent.  The  set  contribution  acts  as  an 
incentive  for  insurersand  providers  to  com- 
pete. 

□ MEDICAL  INDIGENCY-The  condi- 
tion of  having  insufficient  income  to  pay  for 
adequate  medical  care  without  depriving 
oneself  or  dependents  of  food,  clothing, 
shelter, and otheressentialsof living.  Medi- 
cal indigency  may  occur  when  a self-sup- 
porting individual,  able  under  ordinary  con- 
ditions to  provide  basic  maintenance  for 
himself  and  his  family,  is,  in  time  of  cata- 
strophic illness,  unable  to  finance  the  total 
cost  of  medical  care. 

□ NATIONAL  HEALTH  EXPENDI- 

TURES-Total  spending  on  health  services, 
prescriptions  and  over-the-counter  drugs 
and  products,  nursing  home  care,  insur- 
ance costs,  public  health  spending,  and 
health  research  and  construction.  In  1 992, 
the  U.S.  health  expenditures  are  estimated 
at  over  $800  billion. 

□ NON-COVERED  SERVICES-AII  ben- 
efit packages  have  a defined  set  of  basic 
benefits.  For  instance,  mental  health  ben- 
efits may  be  limited  to  a specific  number  of 
visits  per  year  with  a 50%  copayment, 
while  other  services  may  not  be  covered  at 
all.  Often  times  NON-COVERED  services 
are  referred  to  as  exclusions. 


□ OUT-OF-POCKET  PAYMENTS 

OR  EXPENSES-Those  borne  directly  by 
a patient  without  benefit  of  insurance, 
sometimes  called  direct  costs.  Unless 
insured,  these  include  patient  payments 
under  cost-sharing  provisions. 

□ PATIENT  -One  who  is  receiving 
health  services;  sometimes  used  synony- 
mously with  consumer. 

□ PAYER-  An  institutional  payer  such 
as  an  insurance  company,  Health 
Maintenance  Organization  (HMO), 
Preferred  Provider  Organization  (PPO), 
or  government  agency  responsible  for 
paying  the  provider  for  covered  services 
received  by  insured  parties.  In  the  health 
care  industry  there  is  generally  a 
separation  between  the  individual 
receiving  the  service  (the  first  party),  the 
individual  or  institution  providing  the 
service  (the  second  party),  and  the 
organization  paying  for  the  service  (the 
third  party). 

□ PER-CAPITA  HEALTH  SPEND- 
ING -Annual  spending  on  health  care  per 
person.  Per  capita  spending  in  1 992  is 
estimated  at  $3,057. 

□ PHYSICIAN  SERVICES-One 

portion  of  national  health  care  expendi- 
tures. Includes  physicians'  overhead, 
administrative  expenses,  and  income. 
Total  expenditures  for  physician  services 
in  1 990  were  $1 25.7  billion  or  1 8.9%  of 
total  health  spending. 

□ PORTABILITY-An  individual 
changing  jobs  would  be  guaranteed 
coverage  with  the  new  employer, 
without  a waiting  period  or  having  to 
meet  additional  deductible  requirements. 


Colorado  Medicine  for  November,  1993 


415 


thought  you'd  never  ask! 


"Actually,  I don't  believe  I 
have  had  any  CMS  mem- 
ber ask  for  years,  but  I'm 
happy  to  tell  you  how  the 
Colorado  Medical  Society 
process  of  endorsing  a 
product,  service,  or  pro- 
gram works.  Let  me  get 
one  thing  straight  right 
from  the  start:  no  person, 
no  organization,  no  com- 
pany buys  a CMS  en- 
dorsement." 

Bill  Pierson,  Director 
Member  Services 


If  you  have  received  a marketing 
letter  or  brochure  in  the  mail  re- 
cently, outlining  the  merits  of  a 
product,  service,  or  program  which 
bears  the  endorsement  of  the  Colo- 
rado Medical  Society,  that  endorse- 
ment comes  from  research  and  first- 
hand knowledge  of  the  product, 
service,  or  program. 

That  endorsement  does  not, 
however,  imply  any  guarantee 
provided  by  the  Colorado  Medical 
Society.  The  endorsement  is  one 
thing,  and  one  thing  only:  a limited 
recommendation  to  the  CMS  mem- 
ber to  use  or  buy  this  particular 


product,  based  on  the  product's 
review  by  CMS  staff  and  physician 
members.  The  endorsement  is  given 
to  a company,  service,  product  or 
program  which  is  a unique  offering 
that  CMS  feels  will  serve  its  physi- 
cian members  and  their  family. 

No,  CMS  is  not  in  the  automo- 
bile business,  but  very  few  of  its 
4,600  + members  don't  have  need 
for  automobiles.  Therefore,  if  CMS 
can  serve  its  members  through  an 
endorsed  auto  purchasing  plan 
whereby  the  member  saves  money 
and  CMS  benefits  in  income  from 
this  endorsement,  isn't  that  a sensible 
approach?  We  thereby  don't  have  to 
be  experts  on  autos.  And  how  did  we 
arrive  at  the  endorsement?  The  CMS 
policy  is  that  the  endorsement  will 
be  reviewed  each  year  and  that  other 
such  programs,  products  or  services 
will  be  considered  at  that  time. 
Renewal  of  an  existing  endorsement 
wiil  be  determined  by  the  CMS 
Board  of  Directors. 

When  an  endorsement  is  given 
by  the  CMS,  an  agreement  will 
provide  for  some  remuneration  to 
CMS,  usually  in  the  form  of  a yearly 
payment  for  the  use  of  the  CMS 
membership  list  for  mailing  pur- 
poses. However,  before  any  such 
mailing  to  CMS  members  is  done, 
contents  and  purpose  of  the  mailing 
must  be  reviewed  and  approved  by 
CMS,  but  the  mailings  are  done  at  no 
cost  to  CMS.  Even  though  you 
receive  a marketing  flyer  in  the  mail 
that  indirectly  comes  from  CMS,  it 
came  at  no  cost  to  CMS  members  or 
through  the  use  of  any  CMS  funds. 

Other  than  fees,  what  does  a 
commercial  endorsement  do  for 
CMS?  It  puts  CMS  in  more  direct 


contact  with  many  of  its  members 
because  with  all  such  endorsements, 
CMS  asks  that  any  questions  or 
complaints  about  the  endorsed 
product  come  to  CMS  so  that  we 
know  how  good  the  service  is. 

If  you  have  ever  used  a service 
or  a product  that  is  endorsed  by  the 
Colorado  Medical  Society  and  were 
dissatisfied  and  did  not  register  your 
dissatisfaction  with  CMS,  that's  your 
tough  luck  because  we  would  have 
immediately  done  something  about 
the  complaint,  and  it  would  have 
weighed  heavily  in  consideration  of 
any  further  endorsement.  CMS  can 
handle  the  complaints  because, 
believe  me,  we  have  been  careful 
enough  in  our  selecting  products  or 
services  to  be  endorsed  that  we  don't 
get  many  complaints,  and  the  ones 
we  receive  are  often  results  of 
misunderstandings  we  can  clarify, 
rather  than  misrepresentations  or 
inferior  products  or  services. 

By  the  way,  on  the  following 
pages  is  a story  related  to  a CMS 
member  survey  conducted  in  August. 
The  survey  was  a part  of  the  en- 
dorsed member  service  provided  by 
Chase  Manhattan  Financial  Services 
and  the  Physician's  Financial 
Program".  The  survey  was  done  on 
behalf  of  CMS  and  Chase  Manhattan 
but  at  no  cost  to  CMS.  A part  of  the 
survey  was  structured  on  behalf  of 
CMS  and  the  information  will  better 
help  CMS  to  serve  its  members 
during  the  coming  months. 

If  nothing  else,  CMS  has  profited 
tremendously  in  member  relations 
because  of  our  endorsements.  We're 
proud  of  those  services  we  endorse. 


416 


Colorado  Medicine  for  November,  1993 


Health 


Additional  AIDS  Surveillance  Case 
Definition 


In  January  of  1 993,  the  Centers  for 
Disease  Control  revised  the  AIDS 
surveillance  case  definition.  The  new 
definition  included  all  opportunistic 
infections  in  the  1987  case  definition 
plus  the  following: 

1)  Pulmonary  tuberculosis  in 
the  presence  of  HIV  infection. 

2)  Invasive  cervical  cancer  in 
the  presence  of  HIV  infection. 

3)  Recurrent  bacterial  pneumo- 
nia in  the  presence  of  HIV  infection. 

4)  A CD4+ count  of  less  than 
200/mm3,  or  less  than  14%,  in  the 
presence  of  HIV  infection. 

In  order  to  enhance  surveillance  of 
AIDS  as  well  as  HIV  infection,  in 
May  of  1993,  the  Colorado  Board  of 
Health  passed  a regulation  requiring 
that  laboratories  who  perform  CD4+ 
counts  report  those  less  than  500/ 
mm3,  or  less  than  29%,  to  the  state 
health  department. 

Staff  from  the  HIV/STD  Surveil- 
lance program  contact  care  providers 
of  patients  with  reported  CD4+ 
counts  of  less  than  500  to  determine 
their  HIV  status  and  collect  other 
routine  surveillance  information.  If 
the  patient  is  not  HIV  infected, 
records  related  to  that  individual  are 
destroyed. 


Reporting  of  CD4+  counts 
between  200  and  500/mm3  to  the 
health  department  will  allow  surveil- 
lance staff  to  assure  that  these 
persons  receive  appropriate  medical, 
social  services  and  partner  notifica- 
tion referrals  before  they  progress  to 
AIDS. 


Reminder: 
Influenza  Season 
is  Here  Again 

The  season  for  immunizing  your 
patients  against  influenza  is  once 
again  upon  us.  This  year's 
vaccine  is  targeted  to  three  major 
strains  of  virus:  A/T exas/36/91  - 
like  (H1N1);  A/Beijing/32/92-like 
(H3N2);  and  B/Panama/4 5/90- 
like. 

Remember  that  your  elderly 
patients  and  anyone  with 
diabetes,  heart  disease,  lung 
disease  or  kidney  disease  is  at 
risk  for  serious  complications  of 
influenza  and  should  be  vacci- 
nated. 


Call  692-2700  for  more 
information 


Colorado  Medicine  for  November,  1993 


417 


Medical 


News 


Kids  in  Need 

The  Kids  In  Need  (KIN)  Program 
at  The  Children's  Hospital  was 
developed  to  address  the  needs  of 
families  with  children  prenatally 
exposed  to  alcohol  and  drugs. 

The  program  consists  of  three 
separate  components.  First,  there  is  a 
diagnostic  clinic  located  at  The 
Children's  Hospital  called  the  Kids  In 
Need  Clinic.  It  serves  to  evaluate  the 
needs  of  the  children  and  the 
families  and  make  referrals  to 
appropriate  resources.  A clinic  visit 
consists  of: 

-complete  medical  and  family 
history 

-physical  and  psychological 
examinations 

-complete  review  of  school 
records 

-therapy  evaluations  as  needed 
-medication,  when  indicated 
-needs  assessment,  and 
-referral  to  appropriate  agencies 
for  support  services 
The  hope  is  to  increase  the 
overall  functional  abilities  of  chil- 
dren with  alcohol  and  drug  related 
birth  defects  by  working  as  a team  to 
provide  optimal  treatment  that  may 
include  special  education  resources, 
therapy,  medications,  and  the 
support  of  social  service  agencies. 

Second,  the  program  offers  a 
support  group  for  parents.  This 
support  group  is  available  for  foster, 
adoptive,  and  natural  parents  of 
affected  children.  The  goal  is  to  offer 
problem  solving  methods  to  address 
issues  related  to  behavior  problems 
and  teach  children  survival  skills  and 
activities  of  daily  living.  In  addition, 
parents  are  encouraged  to  utilize 


community  support  services  in  order 
to  improve  the  quality  of  life  for  the 
family.  The  support  group  also 
sponsors  speakers  to  address  parental 
concerns  on  a variety  of  parenting 
issues. 

Third,  the  program  coordinates  a 
speakers  bureau  composed  of 
individuals  who  work  with  educators 
and  support  personnel  to  increase 
understanding  of  the  needs  of  these 
children  and  offer  ideas  for  educa- 
tional programming.  Speakers  are 
prepared  to  address  a variety  of 
audiences  to  discuss  medical, 
psychosocial,  and  educational 
aspects  of  the  affected  child. 

For  further  information  call  Dr. 
Donna  Nimec,  Program  Coordinator, 
at  303-861-6037. 

CU-MEDLINE  Plus 
Debuts 

Denison  Memorial  Library  at  the 
University  of  Colorado  Health 
Sciences  Center  is  pleased  to  an- 
nounce that  CU-MEDLINE/Paper- 
Chase  access  will  be  offered  to 
individuals  throughout  Colorado 
beginning  in  the  fall  of  1 993.  The 
new  service,  dubbed  CU-MEDLINE 
Plus , extends  on-line  access  to 
persons  who  are  not  employees  of 
the  Health  Sciences  Center. 

Denison  Library  will  provide 
unlimited  searching  on  CU-MED- 
LINE/PaperChase,  24  hours  per  day, 
365  days  a year,  for  an  annual  flat 
fee  of  $ 1 80  per  searcher.  Individual 
and  group  training,  telephone  and 
electronic  mail  support,  and  a 
communications  software  program 
will  be  included.  Subscribers  will  be 
able  to  access  this  resource  by  using 
a personal  computer,  communica- 


tions software  and  modem.  For  most 
areas  of  the  state  there  will  be  no 
long  distance  telecommunications 
costs  incurred  during  a database 
search.  Searchers  will  also  be  able  to 
request  photocopies  of  pertinent 
articles  by  flagging  citations  they 
retrieve  while  on-line. 

CU-MEDLINE/PaperChase  is  an 
on-line  information  service  that 
searches  the  MEDLINE,  HEALTH 
(Health  Planning  and  Administra- 
tion), CANCERLIT  and  AIDSLINE 
databases  produced  by  the  National 
Library  of  Medicine.  These  files  are 
mounted  at  the  PaperChase  offices  in 
Boston  and  linked  into  the  on-line 
catalog  of  Denison  Library's  books, 
journals  and  audiovisuals.  MEDLINE 
includes  references  to  the  literature 
in  medicine,  surgery,  dentistry, 
nursing  and  health  care  manage- 
ment. HEALTH  covers  topics  in 
hospital  administration,  accreditation 
and  health  care  delivery.  CANCER- 
LIT  includes  references  to  clinical 
and  experimental  therapies,  carcino- 
gensis  and  mutation  studies.  AIDS- 
LINE  includes  both  clinical  and 
research  information  in  addition  to 
references  involving  AIDS  and  health 
care  policy. 

Further  details  will  be  released  in 
the  near  future.  You  may  also 
contact  the  Information  Services 
Department  of  the  library  at  270- 
SI  58  at  any  time. 

Colorado  Coalition 
Moves  Ahead  in 
Immunization 

Part  of  President  Clinton's  strategy 
for  health  care  reform  is  to  provide 
appropriate  immunizations  for  all  the 


418 


Colorado  Medicine  for  November,  1993 


Medical 


children  in  the  country.  In  Colorado, 
we're  a step  ahead  of  the  game.  The 
Colorado  Children's  Immunization 
Coalition,  a state-wide  public/private 
partnership  dedicated  to  fully 
immunizing  children  age  two  and 
younger,  has  hired  a clinical  coordi- 
nator to  work  with  private  and  public 
health  care  providers  to  increase  the 
immunization  rate  of  preschool  age 
children. 

Lori  Stonehocker  Quick  will  be 
headquartered  in  the  Colorado 
Department  of  Health.  Her  job  will 
be  to  do  something  about  the  low 
rate  (60%)  of  immunization  among 
Colorado  children  age  two  and 
younger  against  measles,  mumps  and 
whooping  cough.  The  Coalition 
hopes  to  increase  that  to  90%  by  the 
end  of  1 995. 

The  new  coordinator  has  a 
Master  of  Science  and  Nursing 
degree  and  previous  experience  in 
public  health,  epidemiology  and 
nursing.  She  will  be  visiting  pediatri- 
cians, family  practitioners  and  others 
to  educate  them  about  current 
vaccination  procedures  and  recom- 
mendations. This  is  part  of  the 
Coalition's  plan  which  includes 
elimination  of  cost  barriers,  increas- 
ing opportunities  to  vaccinate 
children  increasing  public  awareness 
of  the  need  for  vaccinations  and 
strengthening  the  current  system  of 
enforcing  immunization  require- 
ments. 

For  more  information,  call  Lori 
Stonehocker  Quick  at  692-2794  in 
the  Colorado  Department  of  Health. 


Donald  J.  Northey,  M.A. 

Clinical  Audiology 
Audiological  Consultants,  Inc. 

• General  Audiology 
• Hearing  aid  evaluations 
• Hearing  aid  dispensing,  service  and  aftercare 
• Amplified  stethoscopes 
• Noise,  swim  and  surgical  ear  plugs 
• Electronic  Shooters  Protection 
ENGLEWOOD  LAKEWOOD 

3575  S.  Sherman  St.,  Suite  #2  2020  Wadsworth,  #4 

761-7600  238-1366 

Providing  a rewarding  hearing  aid  experience  since  1970. 


Your  next  job 
is  on  the  line. 

1-800 -233 '9330 

Finally  you  have  direct  access  to  career  opportunities  across  the 
country.  The  new  Practice  Opportunity  Line  offers  an  easy, 
no  pressure,  confidential  way  to  conduct  a thorough  job  search 
on  your  own,  24  hours  a day.  All  you  have  to  do  is  call,  follow 
the  prompts  and  research  the  openings.  Then  send  a voice  mail 
mini-CV  to  the  opportunities  you  wish  to  pursue.  It's  die  newest, 
fastest  and  simplest  way  to  get  the  job  you  want. 

The  Practice 
Opportunity  Line 

We’re  on  call  for  you. 
fmm  Physidan’s  Market  Information  Center  1*800  *423  *1229 


Colorado  Medicine  for  November,  1993 


419 


Classified  Advertising 


Publication  of  any  advertisement  in  Colorado  Medicine  is  not  an  endorsement  by  the  Colorado  Medical  Society 
of  the  product  or  service.  Colorado  Medicine  magazine  is  the  official  journal  of  the  Colorado  Medical  Society , and 
is  authorized  to  carry  General  Advertising. 


♦ PROFESSIONAL  OPPORTUNITIES 

WHEATRIDGE:  Full  or  part  time  positions 
for  BP/BC  Primary  Care  or  Emergency 
Physicians  in  fast  track  clinic.  Contact  Alex 
Maslanka,  MD.,  Emergency  Service 
Physicians,  8300  West  38th  Ave.  Wheat- 
ridge,  CO.  80033;  (303)  444-761  8. 

2/1 1 93 

ER  Director  for  community  hospital  with 
10,000  annual  visits.  Good  opportunity 
for  Board  Certified  ER  Doc  who  wants  to 
work  in  a growing  community  and  enjoy 
Colorado  recreation  and  sunshine. 
Competitive  pkg.  for  the  director  who 
shares  rotating  schedule  with  3 B/C 
physicians.  Contact  Susan  Hall  at  Platte 
Valley  Med.  Center  1850  Egbert  St. 
Brighton,  CO.  80601.  (303)  659-1531. 

2/1093 

BOARD  CERTIFIED  (M.D.)  GENERAL 
SURGEON  looking  to  relocate  to  Colorado, 
preferably  Denver-Boulderarea.  Available 
soon.  Please  send  inquires  to  Box  R,  C/O 
Colorado  Medical  Society,  P.O.  Box  1 7550, 
Denver,  CO  8021  7-0550.  tfn 


PRACTICE  OPPORTUNITY-  Excellent 
opportunity  for  a Board  Certified  or 
eligible  Family  Practitioner  to  join  a 30 
physician,  well  established  multi- 
specialty group.  LongmontClinic  will  be 
expanding  their  services  to  include  a 
satellite  office  in  a nearby  community. 
Longmont,  Colorado  is  located  45  miles 
north  of  Denver  in  the  beautiful  front 
range  of  the  Rockies.  Longmont  Clinic 
offers  a competitive  salary  with  an 
incentive  program.  Excellent  corporate 
fringe  benefit  program.  For  more 
information  please  contact:  Admin- 
istration, Longmont  Clinic,  P.C.,  1925 
W.  Mountain  View  Avenue,  Longmont, 
CO.  80501,  (303)  776-1234  (Collect). 

2/1193 


TIRED  OF  THE  DAY  TO  DAY  HASSLE  of 

HMO's,  Medicare,  discounted  insurance 
and  being  on  cal  I?  Then  consider  a position 
with  corrections.  Before  you  say  "No  Way," 
call  us  and  find  out  more.  Contact  Roderic 
Gottula,  MD,  10900  Smith  Road,  Denver, 
CO  80239  or  call  (303)  375-21 1 0.6/0793 

ASSOCIATE  MEDICAL  DIRECTOR-  Our 

clients  are  an  international  insurance 
company  and  multi-specialty  medical 
group,  who  provide  primary  care  to  over 
65,000  individualsthrough  a managed  care 
program.  They  are  seeking  an  experienced 
physician  executive  to  assume  the  ongoing 
Medical  Director  responsibilities  of  the 
Point  of  Service  Health  Plan.  This  role  will 
supervise  the  utilization  management, 
quality  improvement,  and  risk  management 
activities  of  the  group  and  will  also  spend 
50%  of  the  time  in  clinical  practice. 
Desired  background  would  includeaMD.. 
degree  and  Board  Certification  in  a primary 
care  specialty  of  Family  Practice,  Internal 
Medicine,  or  Pediatrics.  The  candidate 
should  also  have  five  to  ten  years  of 
experience,  preferably  in  a managed  care 
environment. 

The  position  is  located  in  a modern 
suburban  clinic  in  a beautiful  city  in  the 
southwest.  To  learn  more  about  this 
opportunity,  interested  physicians  may 
contact  Mr.  Richard  Messer  or  Dr.  Bill 
Young  in  complete  confidence  at: 

Young,  Messer,  Koepernik  and  Associates, 
5314  S.  Yale,  Suite  600,  Tulsa,  Oklahoma 
74135,(918)495-1988.  1/1193 

LOCUM  TENENS...  new  adventures,  free 
from  administrative  tasks,  flexibility,  and 
high  earnings.  Assignments  vary:  one  day, 
one  week,  one  month,  long  term,  OR,  time 
off  with  peace  of  mind,  knowing  that  your 
practice  goes  uninterrupted.  Qualified 
physicians  are  ready  to  assist.  Ten  years 
experience;  physician-managed  company. 
Call  INTERIM  PHYSICIANS  today  for 
details. — Denver691  -071 8,  or  1 -800-669- 
0718  12/1292 


FAMILY/GENERAL  PRACTICE  PHYS- 
ICIANS - Northwest  Kansas  community, 
Atwood,  Kansas  offers  many  opportunities 
to  raise  a family  in  a healthy  lifestyle,  and 
stable,  yet  economically  sound  environ- 
ment. Excel lent  clinic  facilities,  outstanding 
benefits  and  call  schedule.  Call  Jeffrey 
Bensman  at  1 -800-638-6942.  3/1 1 93 

BOULDER  - Urgent/Family/Occupational 
Medicine  - Successful  Medical  Center 
seekingtwo  BE/BC  physiciansfor excellent 
opportunity  in  prime  SE  Boulder  area. 
Minimal  call  Flexible  scheduling.  Send  CV 
and  call  Dr.  Turnbow,  Meadows  Medical 
Center,  P.C.,  4800  Baseline,  D-106, 
Boulder,  CO.  80303.  (303)  499-4800. 

4/0893 

PHYSICIANS,  (MD/DO)-  Part-time 
practice,  Denver,  Flight  surgeon,  Disaster 
& Occupational  Medicine.  Expand  your 
horizon  with  the  Air  National  Guard.  Call 
EDD  (307)772-6185.  The  Air  National 
Guard.  9/0293 

BC/BS  FAMILY  PRACTICE  to  staff  minor 
care  clinic  in  Emergency  Room.  Full  or  part 
time  - currently  staffing  weekends.  6 or  1 2 
hour  shifts  available  immediately.  Send  CV 
orcalhTom  Harms,  MD..,  North  Colorado 
Medical  Center,  1 801  1 6th  Street,  Greeley, 
CO.  80631,  (303)  350-6244.  2/1193 

♦ SITUATIONS  WANTED 

RN  EXPERIENCED  21  years  same  medical 
office  desires  challenging  medical  office 
position.  Very  flexible  S/E  Denver.  324- 
2927.  3/0993 

PHYSICIAN  (GP)  LOOKING  FOR  PART 
TIME  OR  FULL  TIME  shortterm  clinic,  occ. 
med.  work.  References  provided.  Have 
own  insurance.  Available  now.  Prefer 
Denver  area.  (303)  320-5960.  1/1 1 93 


420 


Colorado  Medicine  for  November,  1993 


♦ PROPERTIES  FOR  SALE  OR  LEASE 

JEWELL  & WADSWORTH-  Retail/office 
space  for  lease  - excellent  exposure  - free 
standingbuilding-2000squarefeet$l  375/ 
month.  Tenant  finish  $$  available.  Call 
Billy  Halax  973-1380  6/0593 

OFFICE  SPACE  AVAILABLE-  2 Brand  new 
office  spaces  availableto  sublet.  Perfectfor 
part-time  practices.  1)  Lutheran  Medical 
Center,  1600  Sq.  Ft.  4 exam  rooms. 
Availableall  day  Mon.  Wed.  & Fri.  A.M..  2) 
ColumbineMedical  Center,  7325  S.  Pierce, 
1100  Sq.  Ft.,  3 exam  rooms.  Available 
Mon.,  Tues.,  Thurs.  A.M.  All  day  Wed.& 
Fri.  P.M.  Call  761-4343.  1/1193 

♦ EQUIPMENT  FOR  SALE  OR  LEASE 

DUE  TO  INCREASED  CLIA  REGULA- 
TIONS, Moffat  Family  Clinic  is  offering  the 
following  equipment  for  purchase.  Abbott 
Vision  Machine,  IMEX  Lab  9000  Peripheral 
Vascular  System  and  QBC  Reference  System 
Hematology  Analyzer.  For  information 
please  contact  Moffat  Family  Clinic,  600 
Russell,  Craig,  CO  81 625  or  call  (303)824- 
3252.  contact  person  - Judy  Milner,  office 
manager  or  Larry  Kipe,  ME).  3/1 093 

BUY  DIRECT— LOCAL  MFG..  Custom 
Office  Furniture — Desks,  Credenzas, 
bookcases.  Files,  work  stations,  waiting 
room  seating,  etc.  Oak-cherry  & walnut. 
We  build  quality  custom  office  furniture  at 
a price  you  can  afford.  Mark  IV  Systems, 
Inc.  297-1 248.  8:00-4:30  M-F.  1 2/0293 

♦ SERVICES 

DOCTORS/DENTISTS/OFFICE  MGRS.,  Is 

your  accounts  receivable  mounting  due  to 
unpaid/rejected  claims?  Are  you  having 
problems  keeping  your  CPT  and  Diagnosis 
codes  up-to-date?  Let  us  show  you  how  we 
can  help  you  and  help  reduce  your 
administrative  cost.  Call  (303)  840-0998  or 
1 -800-MEDIPAY 
1-800-633-4729 

2/1193 


EXPERIENCED  MEDICAL  TRANSCRIP- 
TIONIST — Surgery/Clinic  dictation — ENT, 
Gl,  General  Surgery,  Neurology,  OB/GYN, 
Orthopedics/Podiatry,  Rheumatology, 
Pediatrics,  Plastics.  Fast,  accurate  — IBM 
PC,  WP  5.1,  Format/Laser  Print.  Home: 
(303)  329-6572/  FAX:  (303)  329-8266. 

3/0993 

QUICK  CLAIM  ELECTRONIC  CLAIMS 
PROCESSORS,  HMO  PPO,  MEDICARE, 
MEDICAID  AND  PATIENTS  BILLING  (303) 
333-8666.  22/0393 

HOME  MORTGAGE  LOANS 
LOW  DOC  PROGRAM  available  for 
physicians  and  other  health  professionals. 
Purchase  and  refinance.  Call  Milt,  a 
mortgage  banker  with  1 8 years  experience. 
753-6262.  12/1292 

YOUR  PC  PAYS—  YOU  BENEFIT-TAX 

DEDUCTIBLE  TO  YOUR  PERSONAL 
CORPORATION.  TAX  FREE  DISTRI- 
BUTION TO  YOU.  $50,000  TO  $ 1 00,000 
EVERY  YEAR  FOR  LIFE  PROVIDES  A 
METHOD  FOR  TRANSFERRING  ASSETS 
FROM  YOUR  PC  TO  YOU  TAX  FREE! 
CALL  H.A.  KLINE  (303)  850-9775.  tfn 

IN  NEED  OF  MEDICAL  - LEGAL  REPRE- 
SENTATION? The  Law  Offices  of  Heckman 
& O'Connor  in  conjunction  with  the  Law 
Offices  of  Grieff  and  Ritchie  are  available 
for  consultation  in  medical  board  disci- 
plinary actions,  hospital  privileges  matters 
and  business  matters.  Phone:800-488-51 1 2 
or  fax:  303-476-9558  or  206-467-6738. 

6/1 1 93 

INNOVATIONS  SHOULD  BE  PATENTED 

if  marketable.  For  more  information  call 
Brian  D.  Smith  of  Fields,  Lewis,  Pittenger  & 
Rost.  Colo's  leading  patent  law  firm.  Mr. 
Smith  specializes  in  the  medical  arts.  (303) 
758-8400.  12/1192 

RESIDENTIAL  REAL  ESTATE  SALES.  Dealing 
in  homes  valued  above  $250,000.  1 2 yrs. 
exper.  BS:  Real  Estate  and  Construction 
Mgmt-D.U.  MS:  Finance  & Tax  - C.U. 
Steven  Carter,  Pres.  Flatiron  RE  Serv. 
Denver/Boulder  (303)888-052 1 1 2/0893 


If  the  objective  is  financial  independence... 
there  is  another  way...  Outsourcing 
through  Clinic  Service  Corporation. 
Established  in  1974  simply  as  a billing 
service,  today  we  offer  Colorado's  most 
extensive  practice  management  package. 
Expandable,  CSC  systems  grow  to  meet 
your  demands.  For  more  information  and 
references  please  call  Yvette  Schrock  at 
777-9674.  4/0893 


BUY-SELL  AGREEMENTS/PARTICI- 
PATING PROVIDERCONTRACTS.  Legal 
assistance  in  the  negotiation  and 
documentation  of  practice  purchases  and 
sales,  and  provider  agreements.  Former 
Blue  Cross  Attorney.  James  E.  Gigax, 
Esq.,  410  - 17th  Street,  Suite  2400, 
Denver,  CO.  80202;  (303)  534-2277. 

2/1093 


AT  LAST!  Colorado  finally  has  a 
Southwestern  owned  and  operated 
Physician  Recruting  company  that 
understands  and  specializes  only  in  the 
Southwest.  Our  proven  policy  of  friendly, 
efficient,  but  affordable  service  is  now 
available  to  meet  your  Permanent  and 
Temporary  Physician  and  Physician 
Assistant  needs.  We'll  visit  your  clinic, 
review  your  requirements  and  search  for 
just  the  right  person.  All  at  no  cost  to  you ! 
You  don't  pay  if  we  don't  succeed.  Call 
us  today!  1 -800-657-0354  or  (602)  433- 
9547,  FAX:  (602)  433-9548.  2/1193 


STOP 
DOMESTIC! 
VIOLENCE 


Chock  The  Box 
On  Your  Colorado 
Tax  Return 

Domestic  Abuse  Assistance 
Programs  Help  Support 

a Prevention  Programs 
a Sate  Homes 
a Counseling 
a Intervention 


Colorado  Medicine  for  November,  1993 


421 


Ruminations 


(def:  chewing  again  what  has  been  chewed  slightly  and  swallowed;  to  REFLECT) 


by  Bill  Pierson , Managing  Editor 


...  I asked  as  calmly  as 
possible , "What  body?" 


Recently,  Lynn  Livingston, 
Administrative  Assistant  in  the  CMS 
Division  of  Health  Care  Policy, 
asked  if  I had  any  advice  for  an 
outside  (non-physician)  caller  who 
wanted  to  know  how  to  donate 
organs. 

My  advice  to  anyone  who  tries 
to  help  someone  in  this  area  is 
"Not!" 

I told  Lynn  that  I remembered  so 
well  a staff  person  at  St.  Luke's 
Hospital  some  years  ago  calling  me 
and  asking  where  I (CMS)  wanted  the 
cadaver  delivered  (s'truth,  honest).  I 
asked  as  calmly  as  possible,  "What 
body?"  She  replied  that  it  was  the 
body  of  a very-recently  deceased 
elderly  male  who  stated  in  his  will 
that  his  body  was  to  be  given  in  the 
name  of  medical  science  to  the 
Colorado  Medical  Society. 

I replied  that  this  was  a kind  and 
generous  gesture,  but  one  which 
should  have  been  made  to  the 
School  of  Medicine  and  not  CMS. 

She  asked,  "Well,  what  do  I do  with 
this  directive  from  his  will?"  My 
suggestion  was  that  she  or  the  heirs 
go  back  to  the  attorney  who  wrote 
the  will  and  have  that  person  make 
the  necessary  correction,  since  it  was 
obviously  an  error,  whether  it  be  a 
posthumous  codicil  or  whatever  they 
want  to  call  it.  She  was  ahead  of  me 
on  this  one:  she  said  that  couldn't  be 
done;  she  wondered  about  this 
business  and  had  already  checked 
when  she  saw  the  body  was  to  go  to 
the  Colorado  Medical  Society.  I 
asked  her  what  she  found  out.  She 
said  she  found  out  the  attorney  who 
wrote  the  will  had  pre-deceased  the 
benefactor  by  three  years,  so  there 
was  no  very  simply  correcting  his 


error.  I asked  the  only  question  I 
could  think  of:  "Could  you  just  hang 
onto  the  body  until  I can  get  some- 
one to  work  on  the  matter  from  this 
end?"  To  make  a long  story  short,  we 
managed  to  have  the  cadaver 
diverted  to  UCHSC  and  everything 
turned  out  all  right. 

When  she  saw  my  reply  to  Lynn, 
Lorraine  Koehn,  our  Government 
Affairs  Program  Manager  tells  an 
interesting  cadaver  story.  Prior  to 
joining  Colorado  Medical  Society  in 
1 978,  Lorraine  worked  for  the  state 
of  South  Dakota  and  the  University 
of  South  Dakota,  and  she  tells  us: 

"I  was  at  the  University  of  South 
Dakota  School  of  Medicine  during 
the  days  of  the  hippie  generation. 

Late  one  Friday  afternoon  a long- 
haired young  man  walked  into  my 
office  and  asked  to  see  the  bodies  in 
the  anatomy  lab.  I asked  him  why 
and  he  said  that  he  had  been  doing  a 
great  deal  of  reading  and  praying 
and  had  determined  that  he  could 
raise  bodies  from  the  dead.  He 
merely  wanted  to  use  our  Anatomy 
Lab  to  practice!!" 

Well,  you  just  never  know. 

By  the  way,  Lynn  gave  the  caller 
the  very  best  possible  advice: 
there  are  two  options  we  know  of: 

1 ) donate  the  whole  body  to  the 
Anatomy  Department  of  UCHSC  for 
teaching  purposes  (phone  270- 
8554),  or  2)  donate  specific  organs  to 
be  used  for  transplants  through  the 
Colorado  Organ  Recovery  System 
(phone  321-0600). 


422 


Colorado  Medicine  for  November,  1993 


STACKS 


tft  ED  in 


c 


D A 


M 


HEALTH  SCIENCES  ui&tocatinS  excellence  in  the  profession  of  medicine" 
^UNIVERSITY  OF  MARYLAND 


;mber,  1993 


STACKS 


BALTIMORE 

DEC  § 1993 


Volume  90,  Number  12 

"Thus  I steer  my  bark, 
and  sail  ...  on  even 
keel  with  gentle  gale." 

Matthew  Green 


SiACKii 


The  C.M.S.  Medicine  is  a good,  stout  ship,  but  she  and  her 
faithful  crew  face  some  stormy  weather.  See  page  431. 


) In  This  Issue: 

Legislative  Outlook  for  1 994 Frederick  A.  Lewis,  Jr.,  MD 

This  Medical  Practice  a Family  Affair Renate  G.  Justin,  AiD 

Reinventing  the  Medical  Society Sandra  L.  Maloney 


When  You  Shop  For 
Malpractice  Insurance, 
Low  Bid  Doesn’t  Always  Give 
You  The  Real  Bottom  Line 


Chances  are,  if  a Colorado  physician,  or  a medical  manager,  comparison  shops 
for  malpractice  insurance,  Copic  Insurance  Company  will  offer  the  best  price, 
when  all  of  the  discounts  and  dividends  are  sorted  out.  ♦♦♦  Even  so,  low  bid 
doesn’t  give  you  the  real  bottom  line.  If  responsiveness  to  policyholder  needs 
and  many -faceted  contributions  to  the  Colorado  physician  community  are 
factored  in,  Copic’s  out-  of-  state  competitors  can’t  even  come  close.  Besides, 

low  bid  could  carry  a very  high  price  if  - as  happened  a few  years  ago  - Copic’s 
competitors  drop  Colorado  like  a hot  potato  and  flee  the  state  when  the  going 
gets  rough,  or  when  the  process  server  drops  the  summons  or  subpoena. 
♦♦♦  Copic’s  here  to  stay.  And,  our  damage  control  and  legal  defense  teams  are 
the  best  in  the  business. 

The  Copic  Bottom  Line. 

It’s  more  than  just  competitive  rates. 


Opc 


Copic  Insurance  Company 

RO.  Box  17540  • Denver,  CO  80217-0540  • (303)  779-0044 


1-800-421-1834 


Colorado 

December,  1993 


Medicine 

Volume  90,  Number  12 


Cover  Story 


In  This  Issue... 

431  Storms  on  the  sea  of  life 


Wm.  Carl  Bailey , MD 
President,  Colorado  Medical  Society 

438  Medical  Practice  in  a Family  Way 

Renate  G.  Justin,  MD 


The  bark  is  a rough  and  ready 
three-master,  equal  to  stormy 
weather.  See  page  431  for  a 
discussion  of  how  this  ap- 
plies to  medicine. 


Departments 


431  President's  Letter 

433 Executive  Director's  Update 

434  Lobby 

436  Health  System  Reform 

446  Definitions 

448Member  Services 

449Medical  News 

449 Inside  CMS 

451  New  Members 

455  Physician  Recognition  Awards 

456 Classified  Advertising 

458  Ruminations 


440 

442 

444 

450 


9Health  Fair 


Robert  M.  Bogin,  MD 


New  Direction  for  Peer  Review 

Thomas  R.  Dunn,  MD 
OSHA  News — What  are  the  fines  for? 

Proud  to  be  a Physician! 

W.  George  Shanks,  MD 


Colorado  Medical  Society 


1 * a 

'Vxw'-'-' 


COLORADO  MEDICAL  SOCIETY 
OFFICERS,  BOARD  MEMBERS  and  AMA  DELEGATES 


1992/1993  Officers 
Wm.  Carl  Bailey,  M.D. 

President 

David  C.  Martz,  M.D. 

President-elect 
Terrance  J.  Sullivan,  M.D. 

Treasurer 

Stuart  O.  Silverberg,  M.D. 

Speaker  of  the  House 
Ted  T.  Lewis,  M.D. 

Vice-speaker  of  the  House 
Sandra  L.  Maloney 

Secretary/Executive  Director 
Leigh  Truitt,  M.D. 

(Immediate  Past  President) 


Board  of  Directors 

Board  of  Directors 

Thomas  J.  Allen,  MD 

Joseph  R.  Tyburczy,  Jr.,  MD 

Stephen  G.  Batuello,  MD 

Denis  J.  Winder,  MD 

John  O.  Cletcher,  Jr.,  MD 

M.  Robert  Yakely,  MD 

Donald  G.  Eckhoff,  MD 

John  E.  Elliff,  MD 

AMA  Delegates 

Jonathan  C.  Feeney,  MD 

Joel  M.  Karlin,  MD 

M.  Ray  Painter,  Jr.,  MD 

David  M.  Knize,  MD 

Richert  E.  Quinn,  Jr.,  MD 

Robert  L.  Kruse,  MD 

Mark  A.  Levine,  MD 

Muryl  L.  Laman,  MD 

John  B.  Muth,  MD 

Alternate  Delegates 

Theresa  A.  Scholz 

Louise  L.  McDonald,  MD 

Robert  D.  McCartney,  MD 

Robert  A.  Nathan,  MD 

Robert  M.  Bogin,  MD 

Lothar  K.  Roller,  MD 

Joel  M.  Karlin,  MD 

Elaine  N.  Scholes,  MD 

W.  George  Shanks,  MD 

Robert  R.  Montgomery, 

Susan  A.  Sherman,  MD 

Legal  Counsel 

COLORADO  MEDICAL  SOCIETY  STAFF 


Executive  Office 

Sandra  L.  Maloney,  Executive  Director 
Mary  Lee  Johnston,  Executive  Admin.  Asst. 
Nancy  L.  Deter,  Manager,  Accounting 


Division  of  Health  Care  Policy 

Ellen  J.  Stein,  Director 

Marilyn  P.  Barton,  Program  Manager 

Lynn  R.  Livingston,  Administrative  Assistant 


Western  Slope  Office 

Dolores  M.  Bennett,  Executive  Secretary 

Division  of  Membership  Information  Services 

Timothy  H.  Roberts,  Director 
Diane  L.  LeHew,  Manager,  Support  Services 
Debra  M.  Jones,  Membership  Coordinator 
Beth  M.  Crusha,  Administrative  Assistant 

Division  of  Professional  Services 

Sandra  M.  Finney,  Director 
Lorraine  K.  Heth,  Program  Manager 
Kirsten  E.  Spilde,  Secretary 


Division  of  Health  Care  Financing 

Edie  K.  Register,  Director 
Marijo  M.  Parkin,  Program  Manager 

Division  of  Government  Relations 

Lorraine  L.  Koehn,  Director 

K.  Suzanne  Hamilton,  Administrative  Assistant 

Division  of  Communications 

William  S.  Pierson,  Director 

Michael  P.  Thompson,  Communications  Mgr. 

Gil  Maestas  II,  Communications  Specialist 


COLORADO  MEDICINE  (ISSN-01 99-7343)  is  published  monthly  as  the  official  journal  of  the  Colorado  Medical  Society,  7800  E.  Dorado  PI.,  Englewood,  CO  801 1 1 . Telephone  (303)  779-5455.  Outside 
Denver  area,  call  1 -800-654-5653.  Second  Class  postage  paid  at  Englewood,  Colorado,  and  at  additional  mailing  offices.  POSTMASTER,  send address  changes  to  COLORADO  MEDICINE,  P.  O.  BOX 
1 7550,  Denver,  CO  80217-0550.  Address  all  correspondence  relating  to  subscriptions,  advertising  or  address  changes,  manuscripts,  organizational  and  other  news  items  regarding  the  editorial  content 
to  the  editorial  and  business  office.  Subscriptions  are  available  for  $30  per  year,  paid  in  advance. 

COLORADO  MEDICINE  magazine  is  the  official  journal  of  the  Colorado  Medical  Society,  but  as  such  is  also  authorized  to  carry  general  advertising.  Publication  of  any  advertisement  in  COLORADO 
MEDICINE  does  not  imply  an  endorsement  or  sponsorship  by  the  Colorado  Medical  Society  of  the  product  or  service  advertised.  Published  articles  represent  opinions  of  the  authors  and  do  not  necessarily 
reflect  the  official  policy  of  the  Colorado  Medical  Society  unless  clearly  specified. 

Sandra  L.  Maloney,  Executive  Editor;  William  S.  Pierson,  Managing  Editor;  Michael  Thompson,  Asst.  Managing  Editor,  Gil  Maestas,  II,  Communications  Specialist 


Member,  Colorado  Press  Association, 


Member,  Colorado  Broadcasters  Association 


428 


Colorado  Medicine  for  December,  1993 


Computer  Talk 

Medical  Practice  Automation  Issues  & Information 

a service  of 

MicroAge 

8620  Wolff  Court  - Westminster,  CO  80030  (303)  427-2121 

Taking  The  Sting  Out  of  Your  Conversion 


Implementing  a computer 
system  in  your  practice  can  be  a 
trying  experience.  Physical  installa- 
tion, staff  training  and  altering  well- 
established  office  routines  combine  to 
create  a fairly  bumpy  period,  usually 
lasting  from  30  to  90  days. 

But,  for  many,  the  most 
stressful  part  of  the  implementation  of 
a new  system  is  the  process  of 
moving  the  data  from  your  old 
system,  whether  it  be  another  com- 
puter, a billing  service  or  ye  olde 
trusty  ledger  cards,  over  to  the  new 
computer.  However  it  is  accom- 
plished, there  are  decisions  to  be 
made  during  this  conversion  of  data 
that  will  affect  the  way  you  use  your 
new  system  from  now  on. 

Here  are  some  tips  that  will 
help  alleviate  the  turmoil  and  trauma 
of  your  data  conversion: 

1.  Have  your  vendor  perform  the  data 
conversion  for  you.  Although  this 
will  cost  you,  it  will  be  well  worth 
the  added  expense,  especially 
considering  that  your  staff  will 
otherwise  have  to  invest  much 
energy  and  frustration  if  they  do 
the  conversion  themselves.  And 
since  you're  paying  your  staff, 
you’ll  be  paying  for  the  conversion 
anyway.  Keep  in  mind  a conver- 
sion is  not  simply  a matter  of  data 
entry.  It  is  a fairly  complicated 
process  involving  many  key 
decisions.  Your  vendor  faces  these 
decisions  every  day.  Hopefully, 
you'll  only  have  to  deal  with  them 
once.  Experience  is  on  their  side. 

2.  Ask  your  vendor  to  put  the 
converted  data  on  your  new  system 
prior  to  your  initial  training  so  your 
staff  can  be  trained  on  real  patient 
account  information  they  are 
already  familiar  with.  This  puts 
flesh  and  blood  on  what  is  other- 


wise a highly  conceptual  experi- 
ence. As  long  as  your  training  is 
monitored  properly  (and  it  should 
be)  there  will  be  little  danger  of 
your  staff  doing  any  serious 
damage  to  actual  data. 

3.  There  is  absolutely  no  need  to  run 
your  old  system  and  your  new 
system  simultaneously  (in  parallel). 
Any  software  package  worth  its 
salt  will  follow  standard  account- 
ing principles  and  provide  enough 
audit  trail  to  make  checking  your 
staffs  work  on  a moment-to- 
moment  basis  a simple  process. 
Parallel  systems  may  sound  great 
in  theory,  but  who  has  to  do  the 
real  work?  Your  staff.  Just  when 
all  their  faculties  are  being  strained 
to  their  maximum  learning  the  ins 
and  outs  of  your  new  system,  you 
are  asking  them  to  work  twice  as 
hard.  Now,  there  are  still  some 
who  maintain  that  parallel  systems 
are  an  important  insurance  policy 
against  problems  in  the  new 
system,  but  under  most  circum- 
stances you  are  only  going  to  add 
considerable  stress  when  you 
should  be  doing  exactly  the 
opposite.  The  damage  inflicted 
will  far  outweigh  any  benefit. 

4.  Do  not  insist  on  an  "electronic" 
conversion.  Contrary  to  popular 
belief,  electronically  transferring 
your  data  from  one  computer 
system  into  another  is  no  guarantee 
of  speed  or  accuracy.  If  it  were 
possible  to  move  data,  bit  by  bit, 
from  one  software  package  into 
another,  without  intervention,  we 
could  probably  call  it  a data 
transfer.  We  call  it  a conversion 
because  it  involves  some  important 
decisions  along  the  way.  And 
because  these  decisions  require  the 
input  and  judgement  of  thinking 


persons,  you  could  easily  pay  as 
much  for  a programmer's  time  as 
you  will  for  properly  supervised 
manual  data  entry.  In  most  cases, 
an  electronic  conversion  will 
require  several  passes  at  the  data 
and/or  much  tweaking  to  get 
everything  right.  This  is  because 
different  systems  store  data  in 
different  ways,  and  their  records 
tend  to  contain  different  items.  In 
addition,  when  we  bypass  the  front 
end  software  edits  geared  toward 
protecting  against  user  error  (e.g. 
invalid  dates),  corrupt  data  can  be 
placed  into  the  destination  system. 

It  is  very  difficult  to  discover  the 
net  effect  of  some  of  these  errors 
until  some  program  within  the  new 
software  (e.g.  the  statement 
program)  encounters  them  down  the 
road.  When  you  add  it  all  up.  the 
total  accumulated  time  dealing  with 
the  vagaries  of  an  electronic 
conversion,  whose  effects  can  be 
felt  for  months,  can  very  easily 
outweigh  any  apparent  benefits.  So 
every  conversion  must  be  evaluated 
on  its  own.  If  there  are  large 
numbers  of  accounts  (5,000  or 
more),  and/or  if  the  vendor  has 
considerable  experience  converting 
from  the  old  software,  then  an 
electronic  conversion  may  be  not 
only  be  feasible,  it  may  be  essential. 

5.  Convert  only  those  accounts  whose 
balances  do  not  equal  zero,  and 
then  do  not  bring  over  the  indivual 
transactions  (a  "detail"  conversion) 
unless  you  really  need  them. 

By  all  means  stay  involved  with 
the  daily  progress  of  your  conversion 
and  ask  questions.  But  keep  in  mind 
that,  although  you  may  feel  as  though 
you  are  boldly  going  where  no  one  has 
gone  before,  in  fact  your  vendor 
makes  the  trek  every  day. 


Colorado  Medicine  for  December,  1993 


429 


Now,  a public  forum  on 
health  care 

that  can  mean  something... 

Clear  Creek  Valley  Medical  Society  Sponsors  Grassroots  Health  Care  Forums 

Clear  Creek  Valley  Medical  Society  is  developing  a series  of 
public  forums  on  ColoradoCare  to  demonstrate  a proactive 
and  positive  approach  to  the  chal  lenges  of  health  care  reform. 
The  forums  are  intended  to  bring  these  important  issues 
before  the  public  and  will  provide  an  opportunity  to  give 
grassroots  feedback  to  key  health  policy  decision-makers  in 
Colorado.  Physicians  as  well  as  the  general  public  are  wel- 
come to  come  and  give  input.  A key  feature  of  the  forums  will 
be  a question/answer  session  from  the  floor  to  the  panelists. 


* lear 
reek 
alley 
edical 


□ciety 


JEFFERSOlNj 
CLEAR  CREEK 
GILPIN  j 
SW  ADAMS  countie: 


The  first  forum  concerning  "The  Benefits  Package"  will  take  place  at  7 PM  January  26, 1 994  at 
Lakewood  High  School. 

The  program  will  be  moderated  by  Clear  Creek  Valley  Medical  Society  President  H.  A.  Yocum, 
M.D.,  and  will  include  four  panelists:  Senator  Sally  Hopper  (R  - District  1 3),  Sherri  Laubach  M.D., 
Elizabeth  Leif,  Chair  of  the  Benefits  Committee  of  the  Governor's  Health  Care  Reform  Initiative 
Task  Force,  and  Gerry  Rising,  Past  President  of  the  Colorado  Group  Insurance  Association. 

The  second  and  third  forums  will  be  held  in  March  and  April;  respective  topics  will  be  "The 
Financing  Mechanisms"  and  "Changing  Relationships  - Will  there  be  freedom  of  choice  for 
patients  and  physicians?"  These  are  significant  and  controversial  points  in  ColoradoCare. 
Specific  details  on  these  additional  forums  will  be  made  available  soon.  Your  input  is  importart 
and  can  make  a difference.  CCVMS  looks  forward  to  your  active  participation  in  these  events. 

If  you  wish  more  information  about  these  public  forums,  call  the  Clear  Creek  Valley  Medical 
Society  at  232-1428.  Here  is  an  opportunity  for  the  general  public  and  the  health  care 
professionals  to  have  direct  one-on-one  discussion  with  the  policymakers  about  critical  health 
care  issues  and  the  proposed  ColoradoCare.  Just  what  will  ColoradoCare  offer  you  in  health  care 
benefits?  Does  anyone  rally  know? 

Clear  Creek  Valley  Medical  Society  has  watched,  listened,  and  participated  in  other  health  care 
reform  programs,  but  there  seemed  to  be  little  success  in  providing  factual  information.  Clear 
Creek  Valley  Medical  Society  wants  to  change  that:  if  the  policymakers  have  the  facts,  you  will 
be  able  to  get  them 


430 


Colorado  Medicine  for  December,  1993 


Wm.  Carl  Bailey,  MD 
President,  1993-1994 


We  feel  grateful  for  having  had 
the  privilege  of  doing  our  jobs  for 
another  year,  and  for  experiencing 
the  warm  satisfactions  which  that 
brings.  Most  of  us  have  had  a good 
year,  much  like  those  which  have 
preceded  it.  We  have  had  a fairly 
clear  understanding  of  who  we  are, 
what  our  role  is,  and  a comfortable 
level  of  personal  prosperity.  Yet  the 
end  of  1993  also  brings  a level  of 
profound  concern.  Not  all  of  us  have 
done  so  well.  Increasingly  I hear 
anecdotes  of  declining  incomes, 
physicians  being  dropped  from 
managed  health  care  schemes,  an 
ever  widening  gulf  between  the  high 
and  the  low  ends  of  the  fee  scales. 
Doctors  everywhere  are  working 
harder,  and  their  overhead  keeps 
rising.  The  portents  of  change  evoke 
an  almost  visceral  reaction  in  most 
physicians.  We  are  by  no  means  so 
sure  of  who  we  will  be  in  the  future, 
what  our  role  will  be,  and  certainly 
we  are  unsure  about  future  prosper- 
ity. All  we  can  be  sure  of  is  that 
there  are  monumental  changes  in  the 
offing. 

A storm  is  approaching,  and  we 
are  desperately  concerned  about 
how  we  will  ride  it  out  and  how  our 
world  will  be  configured  in  its  wake. 

It  is  fascinating  to  observe  how 
different  people  react  to  the  prospect 
of  the  oncoming  storm.  Some  exhibit 
grim-faced  resignation,  taking  the 
view  that  nothing  can  be  done  to 
alter  the  outcome,  and  that  it  is 
senseless  to  try.  By  running  help- 
lessly before  the  tempest  they  risk 
becoming  the  willing  victim  of  self- 
fulfilling  prophecy.  Some,  also 
resigned  to  an  outcome  they  fear,  are 
furiously  laying  by  as  many  stores  as 
possible,  planning  to  scurry  off  to  the 


President's 


nearest  safe  harbor  as  the  waves 
rise,  and  to  quit  the  sea  forever, 
sometimes  in  their  prime.  Others  are 
busily  engaged  in  caulking  the 
seams,  pumping  out  the  bilge, 
battening  the  hatches,  securing 
running  gear,  and  checking  naviga- 
tional aids,  with  particular  attention 
to  the  depth-sounders. 

While  it  is  certainly  true  that, 
there  are  some  storms  that  no  ship 
can  survive,  Common  sense  tells  us 
that  a well-founded  ship,  manned  by 
resolute,  skilled  and  disciplined 
sailors  who  have  courage  and 
conviction  can  make  it  through.  New 
lands  have  been  discovered  in  just 
this  way! 

At  the  risk  perhaps  of  belaboring 
this  somewhat  tortured  metaphor,  I 
am  sure  you  get  my  drift.  The 
physicians  who  plan  to  be  survivors 
are  taking  an  activist  role.  They 
recognize  that  we  are  quite  literally 
all  in  the  same  boat.  If  we  pull 
together  we  can  survive,  and  perhaps 
prosper,  although  we  may  be  sorely 
taxed  in  the  process  (no  pun  in- 
tended). 

One  of  the  things  we  can  do  to 
prepare  is  to  assess  our  crew  and 
the  others  in  the  boat. 

It  is  notable  that  in  all  of  the 
health-care  finance  plans,  the 
reference  is  always  to  that  faceless 
entity,  the  health  care  provider, 
particularly  the  primary  care  pro- 
vider. It  appears  that  as  beauty  is  in 
the  eye  of  the  beholder,  so  a "pro- 
vider " is  whatever  the  viewer 
chooses  to  make  it.  It  therefore  is  not 
at  all  surprising  that  we  have  been 
seeing  so  much  activity,  publicly  and 
in  the  legislature,  on  the  part  of 
alternative  care  providers.  All  seem 
intent  to  achieve  status  as  providers 


The  Holiday  Season  is 
upon  us,  and  with  it  the 
end  of  the  year. 
Traditionally , it  is  both  a 
joyous  time,  and  a time 
for  reflection. 

Some  of  us  approach 
the  end  of  1993  with 
mixed  feelings. 


Colorado  Medicine  for  December,  1993 


431 


"Thus  I steer  my  bark,  and  sail  ...  on  even  keel  with  gentle  gale." 


Matthew  Green 


In  closing ; permit  me 
to  return  to  the  metaphor ; 
and  remind  you  of  the 
French  fisherman's  prayer: 
"O'  Lord , your  ocean  is 
so  big , and  my  boat  is  so 
small". 

Happy  Holidays  and  Keep 
the  Faith! 


in  this  new  legal  sense.  It  remains  to 
be  seen  as  to  how  third  party  payers 
and  the  government  will  deal  with 
these  practitioners. 

Quite  another  issue  is  the  so- 
called  mid-level  providers,  the  nurse 
practitioners,  physician's  assistants, 
and  various  therapists.  These  are 
essentially  creatures  of  our  own 
making.  Their  knowledge  and  skills 
are  based  on  the  same  body  of 
science  as  our  own,  and  in  large  part 
have  been  their  teachers.  On  many 
occasions,  they  have  taught  us.  We 
have  a long  history  of  working 
closely  and  productively  with  these 
people  in  their  role  both  as  physician 
extenders,  and  as  practitioners  of 
respected  disciplines  in  their  own 
right.  However,  recently  some  have 
sought  to  stretch  the  envelope  of 
practice  in  ways  that  may  sometimes 
seem  inappropriate  to  physicians. 

In  any  case , definition  of  "scope 
of  practice"  is  going  to  be  a critical 
matter. 

The  health  of  the  people  is  not 
well  served  by  wasting  precious 
resources  on  treatments  of  no 
scientifically  documented  value,  and 
which  may  even  be  harmful  or  result 
in  delay  of  appropriate  therapies.  In 
these  matters,  CMS  is  being  called 
upon  to  research  and  testify  in 
legislative  hearings.  This  would  seem 
less  troublesome  to  me,  if  the 
legislature  had  a higher  regard  for 
our  opinion.  The  potential  conflict  of 
interest  creates  an  environment  of 
suspicion  that  almost  no  amount  of 
good  will  on  our  part  cm  surmount. 

It  might  be  better  if  the  State  regula- 
tory agencies  or  the  medical  school 
could  take  on  this  responsibility,  and 
free  the  practicing  community  of  this 
onerous  and  frustrating  task.  Yet,  in 


the  absence  of  their  input,  we  have 
no  choice  but  to  continue  our  efforts 
as  honestly  as  we  can. 

Finally,  it  is  time  to  look  at 
medical  manpower  in  the  state. 

With  the  outcry  for  more  primary 
care  providers,  and  fewer  specialists, 
demands  are  being  made  on  medical 
schools  by  both  state  and  federal 
governments,  to  alter  the  mix  of 
trainees  in  various  fields.  Some  of  the 
demands,  such  as  requiring  medical 
students  to  commit  to  particular 
fields  even  before  they  enter  medical 
school  are  patently  unworkable. 
Nonetheless,  to  aid  in  this  critical 
endeavor  of  managing  health  care 
resources  and  to  nurture  our  own 
profession,  it  is  important  for  the 
Colorado  Medical  Society  and  for 
our  medical  school  to  develop  some 
real  data  pertaining  to  the  number  of 
physicians  practicing  in  Colorado: 
type  of  practice,  specialty,  type  of 
community  (rural  or  urban),  etc. 

Amazingly , this  kind  of  informa- 
tion is  very  difficult  to  obtain , and 
we  don't  have  it.  We  need  to  know 
this  in  order  to  predict  what  our 
future  needs  will  be,  and  to  monitor 
the  distribution  of  physicians 
throughout  the  state.  In  addition,  it 
would  be  most  helpful  to  develop 
information  about  life-style,  career 
satisfaction  and  other  issues. 

Three  to  five  years  from  now,  it 
will  be  critical  for  the  nation  which 
has  developed  the  highest  quality  of 
medicine  known  in  history  to  know 
how  the  changes  we  anticipate  have 
affected  our  physicians  and  the  care 
they  deliver.  I hope  you  will  assist  us 
in  gathering  some  of  this  information 
when  the  time  comes. 


432 


Colorado  Medicine  for  December,  1993 


Executive 


Director's 


Sandra  L.  Maloney 
Executive  Director 
Colorado  Medical  Society 


The  1993  calendar 
year  is  drawing  to  an  end. 
The  time  goes  by  so 
quickly 

It  seems  that  just  yes- 
terday Dr.  Butler  and  I 
were  traveling  the  state, 
getting  your  input  on  the 
Colorado  Medical  Society 
Health  System  Reform 
Policy. 

We  have  now  modified  that 
policy,  and  are  reviewing 
President  Clinton’s  Health 
Security  Act.  During  most  of  1993, 
Dr.  Truitt  and  I traveled  the  state, 
but  with  a different  message.  Dr. 
Truitt  spoke  to  managed  competi- 
tion, and  educated  us  all  on  the 
“virtues”  of  ColoradoCare. 

Recognizing  that  changes  to 
overall  health  care  delivery  would 
impact  the  way  your  Medical 
Society  operated,  Dr.  Bill  Bailey  has 
undertaken  the  arduous  task  of 
streamlining  and  re-focusing  CMS. 
He  began  this  process  at  the 
President-elect’s  Planning  Confer- 
ence last  July.  Five  major  areas 
were  identified  as  priorities,  1) 
organizational  structure,  2)  informa- 
tion, 3)  quality,  4)  membership,  and 
5)  allied  health  providers. 


At  the  1993  Annual  Meeting,  the 
House  adopted  a resolution  which 
sunset  the  Council  on  Professional 
Education,  the  Council  on  Physi- 
cian/Patient Advocacy,  the  Council 
on  Medical  Service  and  the  Council 
on  Community  Health.  The  new 
policy  creates  a new  “super” 
council,  the  Health  Affairs  Council 
(HAC).  This  new  council  will  ad- 
dress all  of  the  issues  previously 
handled  by  the  other  four  councils. 
With  this  change,  we  now  have 
three  councils,  the  Council  on 
Ethical  and  Judicial  Affairs,  the 
Health  Affairs  Council,  and  the 
Council  on  Legislation. 

With  foresight,  Doctor  Bailey 
has  placed  a greater  emphasis  on 
state  and  federal  legislation.  We 
(Dr.  Bailey,  President-elect  Dr. 

David  Martz,  and  CMS  staff)  have 
weekly  meetings  with  the  chair  of 
the  Council  on  Legislation,  Dr.  Fred 
Lewis.  Several  key  state  legislators 
feel  that  the  1994  and  1995  legisla- 
tive sessions  will  be  very  important 
to  physicians.  It  is  predicted  that 
bills  will  be  introduced  which,  at  a 
minimum,  address  insurance  reform 
and  cost  containment.  (No  definition 
of  cost  containment  has  been 
provided.)  Legislators  are  asking 
why  CMS  has  not  done  more  in  the 
way  of  addressing  the  problems  of 
health  care  delivery  in  rural  Colo- 
rado, as  well  as  to  help  address 
care  to  the  medically  indigent.  CMS 
is  not  as  respected  at  the  Capitol  as 
we  should  be.  We  should  be  looked 
upon  as  the  reliable  expert,  and 
certainly  an  organization  which  is 
willing  to  work  in  partnership  with 


others  to  solve  statewide  problems. 
The  time  of  CMS  being  perceived 
as  “just  another  self-interest  group” 
is  long  past.  The  next  couple  of 
years  are  too  critical  for  us  to 
continue  along  this  rocky  path. 

There  are  three  issues:  1)  improving 
the  image  of  CMS  at  the  Capitol;  2) 
more  physician  involvement  in 
legislative  activities,  and;  3)  stream- 
lining to  address  fiscal  constraints. 
With  these  three  issues  in  mind,  the 
CMS  Department  of  Government 
Relations  is  being  re-structured. 
Lorraine  Koehn  has  been  promoted 
to  Director  of  this  department. 
Lorraine  and  I,  along  with  Drs. 

Lewis,  Bailey,  and  Martz,  are 
establishing  legislative  goals  and 
priorities.  Also,  we  are  identifying 
physician  experts  who  can  provide 
analysis  and  testimony  on  legisla- 
tive proposals.  The  matter  of  hiring 
a contract  lobbyist  is  under  serious 
consideration.  It  has  been  strongly 
suggested  that  I become  more 
involved  in  legislative  activities.  I will 
do  so. 

Organizational  changes  that 
necessitate  changes  in  staff  are 
never  easy;  however,  this  change 
will  benefit  all  CMS  members.  In 
this  case,  change  must  be  looked 
upon  as  progress. 

1994  will  undoubtedly  be  a 
challenge  for  organized  medicine. 
With  the  strong  physician  leadership 
within  CMS,  we  will  meet  the 
challenge. 

I wish  each  of  you  Happy 
Holidays  and  a very  happy  and 
healthy  New  Year! 


Colorado  Medicine  for  December,  1993 


433 


by  Frederick  A.  Lewis,  Jr.,  MD 
Chairman,  CMS  Council  on  Legislation 


Lobby 


As  of  September : CMS  has 
three  councils  - the  Coun- 
cil on  Ethical  and  Judicial 
Affairs , the  Health  Affairs 
Council,  and  the  Council 
on  Legislation. 


In  this  and  succeeding  issues  of 
Colorado  Medicine  I will  attempt 
to  keep  CMS  members  current 
on  the  events  in  the  legislative  arena, 
at  least  from  my  perspective.  At  the 
outset  I will  begin  with  the  caveat 
that  my  perspective  may  be  biased 
and,  in  fact,  from  time  to  time  I may 
even  attempt  to  predict  the  future.  As 
all  of  you  know,  this  kind  of  behav- 
ior is  inherently  foolish  and  fraught 
with  danger.  I would  encourage  all 
of  you  to  be  charitable. 


In  line  with  instructions  from  the 
CMS  Board  of  Directors  and  House 
of  Delegates,  the  Legislative  Council 
has  been  restructured.  Members 
have  been  appointed  by  the  Board  of 
Directors.  We  have  established  a 
written,  flexible  list  of  legislative 
priorities  and  have  begun  to  delegate 
the  responsibility  for  doing  advance 
research.  We  would  like  to  encour- 
age input  into  the  legislative  process 
from  all  members  of  the  Society  and 
invite  your  letters  and  comments. 

This  report  is  being  written  with 
the  assumption  that  you  are  as  tired 
of  health  care  reform  as  I am  and 
will  be  an  attempt  to  convince  you 
that  it  will  not  be  a major  issue  this 
year,  at  least  not  at  the  local  level.  It 
is  early  November,  shortly  after  the 
fall  elections  and  the  Republican 
candidates  have  swept  the  national 
elections.  The  early  predictions  are 
that  this  does  not  bode  well  for  the 
future  of  Clinton's  legislative  propos- 
als. NAFTA  will  have  been  decided 
by  the  time  you  read  this.  If  that  has 
also  gone  down  to  defeat,  it  will  be 
another  ominous  omen  for  the 
current  administration.  The  conven- 
tional wisdom  is  that  this  will 
persuade  Congress  to  be  somewhat 
more  conservative  in  its  approach  to 
health  care  reform. 

There  has  been  a continuous 
media  flow  concerning  health  care 
reform  and  I would  caution  you  to 
take  almost  everything  you  hear  or 
read  with  a grain  of  salt  and  a large 
dose  of  cynicism.  Almost  everyone 
has  an  axe  to  grind  but  presents  their 
point  of  view  in  terms  of  what  is  best 
for  the  country.  We  will  probably  not 
wee  a serious  attempt  by  Congress  to 
pass  health  legislation  until  the 
summer  or  early  fall  of  1 994.  The 


deadline  has  been  set  by  the  Novem- 
ber 1 994  elections  when  all  of  the 
House  and  one-third  of  the  Senate 
will  be  up  for  reelection.  Congress 
will  make  all  of  its  decisions  be- 
tween now  and  then  with  this  fact 
uppermost  in  its  (collective)  mind.  If 
the  members  of  Congress  perceive 
that  the  public  expects  some  type  of 
health  legislation  to  be  passed,  then 
a bill  will  be  passed.  If  the  percep- 
tion is  that  the  public  is  in  favor  of 
the  status  quo,  no  meaningful 
legislation  will  emerge.  (We  seem  to 
have  entered  a phase  of  government 
by  the  most  recent  poll.)  Even  if  a bill 
does  pass,  there  is  almost  universal 
agreement  that  the  final  legislation 
will  resemble  Clinton's  original  bill 
in  name  only.  The  major  difficulty 
for  the  Republican  party  is  that,  no 
matter  what  the  final  bill  looks  like, 
Clinton  may  get  the  credit. 

Six  health  care  reform  bills  have 
been  introduced  into  Congress  thus 
far,  and  more  may  be  on  the  way.  At 
this  point  most  Congressmen  are 
keeping  all  of  their  options  open. 
Many  of  them  are  signing  on  as 
cosponsors  of  more  than  one  health 
care  reform  bill.  Most  of  them  want 
to  be  able  to  campaign  on  the  basis 
that  they  helped  sponsor  the  legisla- 
tive initiative  which  finally  passes. 
One  suspects  that  public  opinion  (or 
at  least  Congress's  perception  of 
public  opinion)  will  play  an  ex- 
tremely important  role  in  shaping  the 
final  legislation.  This  means  that  all 
of  you  should  get  involved  in  the 
current  debate  and  make  your  views 
known  to  your  Senators,  Representa- 
tives, patients,  and  friends.  This  is 
not  an  up  or  down  vote  on  Clinton's 
plan.  The  final  outcome  is  ;between 
many  competing  interests.  This  is 


434 


Colorado  Medicine  for  December,  1993 


one  time  that  your  voice  may  well 
make  a very  big  difference. 

Of  special  interest  to  me  is  the 
fact  that  the  national  debate  has 
begun  to  be  structured  around  a ph 
philosophical  discussion  of  how 
much  government  regulation  is 
necessary  and/or  desirable  in  a 
democracy  such  as  ours.  If  this  trend 
continues,  we  may  see  a significant 
reduction  in  the  power  granted  to  the 
federal  bureaucracy.  To  my  mind, 
this  is  good. 

The  general  public,  understand- 
ably, is  most  concerned  about  the 
decreased  availability  of  health 
insurance.  As  business  complains 
about  increasing  costs,  insurance 
companies  have  responded  by 
reducing  their  risk,  insuring  as  many 
healthy  patients  as  they  can,  exclud- 
ing patients  with  chronic  illness, 
preexisting  conditions,  and  institut- 
ing tight  "managed  care"  restrictions. 
It  has  become  quite  difficult  for 
patients  to  buy  individual  coverage. 
Some  people  work  primarily  so  that 
they  can  buy  group  health  insurance. 
Continuity  of  care  is  disrupted  when 
companies  switch  health  insurance 
companies  yearly  to  save  money. 

However,  all  of  these  are 
problems  which  can  be  solved  by 
insurance  reform,  which  may  be  the 
next  step  on  the  way  to  a solution  at 
both  the  national  and  state  levels. 
Broadening  insurance  benefits 
should  be  of  help  to  our  patients. 

Events  are  somewhat  simpler  at 
the  state  level  even  though  they  are 
also  heavily  influenced  by  the 
November  elections.  Significant 
health  care  reform  can  not  be  passed 
without  raising  taxes.  Neither  the 
Republican  nor  the  Democrat  party 
wants  to  go  into  the  1994  campaign 
supporting  a ballot  initiative  raising 
taxes.  At  this  point,  it  seems  likely 
that  our  state  legislature  will  pass 
insurance  reform  which  may  be 
labeled  health  care  reform.  This 
should  turn  out  to  be  a rational 
decision  for  Colorado  and  give  us 
the  chance  to  discover  the  substance 
of  national  legislation  before  passing 
state  health  legislation. 

Other  health  care  initiatives 
which  may  appear  in  the  Colorado 
legislature  are  attempts  at  containing 
medical  costs.  These  are  less  likely  to 


be  welcomed  by  most  physicians. 
Medicaid  funding  is  a serious 
problem  in  the  State  budget  and  we 
would  hope  that  CMS  might  help  the 
Joint  Budget  Committee  find  some 
solution  other  than  continuing  to 
reduce  physician  reimbursement 
from  its  already  anemic  level./  In  the 
private  sector,  there  is  some  evi- 
dence that  the  reorganization  of  the 
health  care  delivery  system  which 
has  been  taking  place  in  Colorado 
over  the  past  several  years  has  begun 
to  reduce  the  escalation  in  health 
care  costs.  If  we  can  persuade  our 
legislature  to  exercise  a little  pa- 
tience, it  seems  likely  that  health 
care  costs  will  be  controlled  by 
private  sector  initiatives.  If  this 
proves  to  be  true,  further  government 
intrusion  into  health  care  systems 
can  be  avoided.  This  simply  has  to 
be  good  for  our  citizens,  our  pa- 
tients, and  society  in  general. 

The  main  purpose  of  this  article 
has  been  to  explain  why  health  care 
reform  does  not  seem  to  be  the 
burning  issue,  despite  the  fact  that  it 
is  all  one  reads  about  in  the  local 
paper. 

If  I am  correct,  I promise  to  move 
on  to  different  issues  in  future  articles. 


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Colorado  Medicine  for  December,  1993 


435 


Health 


System 


Reform 


(above,  from  left)  Doug  Jones,  MD,  Children's  Hospital  Pediatrician-in-Chief; 
Edward  Rhodes,  MD,  Denver  Urologist;  U.S.  Senator  Phil  Gramm;  US. 
Representative  Dan  Schaeffer;  Peg  Brown  (no  relation) , representing  U.S. 
Senator  Hank  Brown  of  Colorado. 

Below,  CMS  Board  member  David  Knize,  MD,  Colorado  Senator  Claire 
Traylor  and  Colorado  Representative  Norma  Anderson  are  among  those 
joining  CMS  President  Wm.  Carl  Bailey,  MD  in  viewing  the  presentation  of 
Edward  Rhodes,  MD  on  the  burden  of  federal  regulations. 


U.S.  Senator  Phil  Gramm  (R-TX)  was 
the  featured  speaker  at  a "town  hall" 
meeting  in  November,  sponsored  by 
The  Children's  Hospital  in  Denver. 
Senator  Gramm,  one  of  the  leaders 
in  bringing  alternatives  to  the 
President's  health  care  plan,  told  an 
overflow  crowd  that  we  must  not  let 
emotion  overwhelm  the  debate  over 
health  care  reform.  He  said  that  the 
health  care  delivery  system  in  the 
U.S.  needs  some  work,  but  certainly 
not  the  major  reconstruction  pro- 
posed by  the  Clinton  administration. 
Whatever  the  problems,  he  said, 
central  planning  at  the  federal  level 
is  certainly  not  the  answer. 

Senator  Gramm  challenged  the 
group  to  come  up  with  even  one 
example  where  the  federal  govern- 
ment did  a better  job  at  less  cost  than 
the  private  sector.  He  said  that  the 
only  case  where  the  federal  govern- 
ment is  the  sole  buyer  of  goods  and 
services  at  present  is  the  Department 
of  Defense.  That  means,  according  to 
Senator  Gramm,  that  federal  take- 
over of  health  insurance  would  yield 
a system  with  the  compassion  of  the 
IRS  and  the  efficiency  of  the  Postal 
Service,  all  at  Pentagon  prices. 


436 


Colorado  Medicine  for  December,  1993 


Health  System 


Reform 


Story  by  Michael  P.  Thompson , Assistant  Managing  Editor 

Photos  by  Gil  Maestas,  II 


CMS  President  Wm.  Carl  Bailey, 
MD  liked  some  of  the  Senator's 
ideas,  though  he  expressed  reserva- 
tions on  others.  He  said  the  primary 
concern  of  the  medical  profession  is 
how  well  patients  are  going  to  fare 
under  any  plan. 

Senator  Gramm  was  backed  up 
by  Representative  Dan  Schaeffer  (R- 
CO)  who  dealt  with  the  local  angle 
such  as  ColoradoCare  and  how  it 
might  interact  with  proposed  federal 
legislation.  Senator  John  McCain  of 
Arizona  was  prevented  from  attend- 
ing by  mechanical  problems  in  the 


airplane  he  was  to  take. 

Edward  Rhodes,  MD  a Denver 
urologist  and  member  of  the  Colo- 
rado Medical  Society,  preceded 
Senator  Gramm  with  a presentation 
on  the  restrictions  his  office  currently 
operates  under.  He  showed  the 
group  a delivery  cart  stacked  about 
four  feet  high  with  rules  and  regula- 
tions he  has  to  deal  with  every  day. 
He  said  that  federal  programs  are 
largely  responsible  for  this  costly 
burden,  leaving  little  hope  that  a 
federal  health  care  system  will 
alleviate  the  problem. 


For  Official  Use  Only 


Health  Plan  Information 


1)  Last  Name: 

4)  Patient  Identification  Number 
6)  Patient  Signature: 

8)  Release  Medical  Inlormabon? 


MEDICAL  CLAIM  FORM 


2)  Health  Plan  Number 


/' 


2)  First  Name: ; 

- r | 

5)  Gender  \ 

a V 

Yes:  |no: 

> 

C 


Subscriber  Information 


1)  Last  Name. 

4)  Subscribe*  Identification  Number 


1)  Is  need  lor  care:  a.  Employment-related? 

c Other  acadenfrS^S? 
e Emergen^?, 

2)  Initial  Diagnosis: 


4)  Description  ot  Encountef^-^^ 

Dates  of  Service:'  \ 

/ 7 •J'  Xc^^j^^^PIaceof  'TXagnosis  Procedure  Units/Days  Covered  Non -covered  Co-pay  Optional 
‘From  ^ Code:  Code:  ol Service:  Charges.  Charges.  Collected  Feld: 


-i.'K 

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/ / 

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UNI’l'KIl,  «I  ATKS  QE  AMEMCA 


(left)  Simplified  medical  claim  form 
proposed  by  the  Clinton 
administration,  (top)  Health  Security 
Card  favored  by  President  Clinton  as 
part  of  a national  health  insurance 
plan. 

Note:  Top  of  the  list  of  items  "not 
covered"  by  Health  Security 
according  to  recent  news  release 
from  the  White  House:  "Services  that 
are  not  Medically  Necessary  or 
Appropriate". 

Unanswered  question:  Who  makes 
those  decisions , the  physician 
involved  in  the  case  or  a bureaucrat 
in  Washington? 


Health  Care  Provider  Information 


IJName: 

3)  Signature 


2)  Identification  Number 
4)  Date: 


Colorado  Medicine  for  December,  1993 


437 


F amily  Practice 


The  best  decision  I ever 
made  was  to  join  my 
daughter  in  her  family 
practice! 


Renate  G.  Justin,  M.D. 


Yes,  we  answer  questions  every 
day  from  our  patients  — "Are  you 
related  to  the  other  Dr.  Justin?  Is 
Ingrid  your  sister?"  "No,  we  are 
mother  and  daughter."  Our  patients 
respond  with  pleasure  and  surprise: 
"That's  great!"  They  muse:  "I've  not 
heard  of  a mother-daughter,  only 
father-son  teams.  How  do  you  get 
along?"  "Do  you  like  working 
together?" 

Six  years  ago,  I was  engaged  in 
an  active,  remunerative  practice  of 
my  own  in  a community  in  which  I 
had  lived  for  thirty  yeas.  Overhead 
and  paper  work  were  gobbling  up 
my  leisure  time  and  I was  ready  for  a 
change,  but  hesitated  to  accept  my 
daughter's  offer  to  work  with  her. 
Would  our  friendship  and  the  deep 
love  we  felt  for  each  other  suffer  if 
we  became  professional  associates? 
Carol  Gilligan,  with  her  description 
of  the  evolving  relationships  of 
mothers  and  daughters  gave  me 
courage.  Her  keen  insight  confirmed 
for  me  that  daughters  have  no  great 
need  to  separate  from  or  reject,  their 
mothers,  as  we  have  been  led  to 
beiieve.  Mothers  and  daughters  can 
relate  to  each  other  as  adults  on  an 
equal  footing  in  "the  progression  of 
relationships  toward  a maturity  of 
interdependence."1  I sold  my  prac- 
tice and  moved  West. 

In  spite  of  having  to  live  with  a 
mother  who  would  run  off  in  the 
middle  of  bedtime  stories  and 
birthday  parties  to  deliver  babies  and 
stitch  up  lacerations,  my  son  and 
daughter  chose  a career  in  medicine. 
The  deep  satisfaction  I experienced 
in  my  work  may  have  influenced 
their  choice.  Today,  their  own 
contentment  may,  in  turn,  influence 


their  children's  professional  goals. 

I remember  the  day  I received 
my  letter  of  acceptance  to  medical 
school  forty-five  years  ago.  I also 
remember  vividly  the  same  event  for 
my  daughter  and  my  son,  now  a 
radiologist.  "The  Exam  Dream"2 
haunted  me  when  I took  basic 
science  finals;  "I  trembled  in  my 
dream  that  I would  fail. "2  The  same 
nightmare  recurred  when  my 
daughter  and  my  son  faced  these 
formidable  obstacles.  During  medi- 
cal school  and  residency,  my 
daughter  spent  a rotation  in  my 
office  and  decided  to  go  into  family 
medicine.  When  she  was  well 
established  in  her  own  practice  she 
invited  me  to  join  her. 

I chose  to  be  Ingrid's  employee 
rather  than  her  partner,  but  we  share 
the  duties  of  running  the  office  and 
have  regular  times  assigned  to  both 
doctor  and  office  meetings.  We  pick 
each  other's  brains  when  we  get 
stuck  and  can't  solve  a problem;  we 
complement  each  other's  profes- 
sional skills.  Ingrid  is  trained  to 
perform  colposcopy,  and  I can 
identify  Coplick  spots,  rashes  and 
diseases  infrequently  seen  today  but 
common  three  decades  ago. 

We  see  eye  to  eye,  philosophi- 
cally; our  practice  style  is  similar, 
with  much  emphasis  on  patient 
autonomy,  and  therefore,  on  our 
duty  to  teach  and  inform  our  patients 
about  our  thinking  process.  We  try  to 
encourage  people  to  take  charge  of 
their  own  health,  stop  smoking, 
exercise,  avoid  excess  alcohol  and 
drug  use.  Our  patients  are  intrigued 
by  our  partnership.  They  get  our 
names  confused  but  are  pleased  by 
our  harmonious  relationship.  Col- 


438 


Colorado  Medicine  for  December,  1993 


by  Renate  C.  Justin,  M.D. 

Family  Practice 
Fort  Collins , CO 


leagues  also  have  difficulty  with  our 
identity  and  names.  Last  week  the 
emergency  room  physician  was 
reprimanded  by  my  patient  when  he 
referred  to  me  as  'the  old  Justin.' 

Patients  choose  one  of  us  a 
primary  physician  to  enhance 
continuity  of  care,  but  they  are  free 
to  switch  any  time.  Since  we  cover 
for  each  other,  most  patients  know 
both  of  us.  When  Dr.  Ingrid's 
patients  see  me  and  comment  on  her 
competence  and  compassion,  I 
absorb  the  praise  as  if  it  were  meant 
for  me. 

By  observing  my  granddaugh- 
ters' play  I have  learned  how  all 
pervasive  medicine  becomes  to  a 
child  whose  parent  is  a physician. 
Five  and  a half  year  old  Johanna 
takes  a very  competent  medical 
history  from  her  three  and  a half  year 
old  sister,  Leah.  "Well,  let  me  see, 
how  did  you  hurt  your  leg?"  "I  broke 
it,  it's  bad;  it  hurts."  "Did  you  fall? 
May  be  you  need  a cast."  While 
comforting  the  patient  they  proceed 
to  make  a cast  out  of  wet  tissues. 
Numerous  'pretend'  telephone  calls 
follow  during  which  they  accurately 
mimic  our  intonation  and  instruc- 
tions; "Give  her  some  tylenol  and 
antibiotics".  Will  they  follow  in  their 
mother's  footsteps? 

Because  my  daughter  has  young 
children,  she  works  fewer  and  more 
flexible  hours  than  I do.  When  one 
of  them  has  an  earache  or  plans  for  a 
special  outing,  I am  glad  to  take  call 
so  Ingrid  can  be  with  her  children, 
my  grandchildren! 

Looking  back,  I wish  I could 
have  called  on  a doctor-grandmother 
when  my  own  children  had  special 
needs.  Then,  their  birthday  parties 


would  not  have  been  interrupted  by 
deliveries;  bedtime  stories  would 
have  been  read  to  their  end.  Besides 
professional  satisfaction,  there  are  a 
lot  of  advantages  to  mother-daughter 
family  practice!  Being  colleagues  has 
deepened  our  respect  and  love  for 
each  other  and  continues  to  be  a 
joyous  experience. 


References 

1 Carol  Gilligan:  "In  a Different  Voice", 
Harvard  University  Press,  Cambridge, 
MA  1982:  p.l  55. 

2 Erica  Jong:  "Becoming  Light,  Poems. 
New  and  Selected",  Harper  Collins, 
1991 : p.297. 


Looking  back , / wish  I 
could  have  called  on  a 
doctor-grandmother  when 
my  own  children  had 
special  needs. 


Ingrid  Justin,  M.D. 


Donald  J.  Northey,  M.A. 

Clinical  Audiology 
Audiological  Consultants,  Inc. 

• General  Audiology 
• Hearing  aid  evaluations 
• Hearing  aid  dispensing,  service  and  aftercare 
• Amplified  stethoscopes 
• Noise,  swim  and  surgical  ear  plugs 
• Electronic  Shooters  Protection 
ENGLEWOOD  LAKEWOOD 

3575  S.  Sherman  St.,  Suite  #2  2020  Wadsworth,  #4 

761-7600  238-1366 

Providing  a rewarding  hearing  aid  experience  since  1970. 


Colorado  Medicine  for  December,  1993 


439 


Following  is  the  opening  day  speech  delivered  by  Rob  Bogin,  M.D.,  to  some  125  participants  and  volunteers  for  the 
1994  9Health  Fair  campaign. 


It  is  a distinct  pleasure 
for  me  to  be  here  for  the 
kick-off  of  the  1994 
9Health  Fairs.  With  your 
involvement  and  the  in- 
volvement of  the  thou- 
sands of  other  volunteers , 
the  9ldealth  Fair  will  no 
doubt  be  as  successful  in 
this , its  15th  year,  as  it  has 
been  in  each  of  the  pre- 
ceding, thanks  to  you. 


In  1 993,  there  were  nearly  forty 
thousand  participants  at  the  9Health 
Fairs,  at  a total  of  1 1 1 different  sites. 
As  many  of  you  well  know,  seven 
basic  screenings  are  offered,  includ- 
ing blood  pressure,  colon  cancer 
screenings,  blood  chemistry  as  well 
as  optional  prostate  blood  testing  for 
men. 

Many  sites  include  skin  cancer 
screenings,  breast  exams,  and 
hearing  tests. 

Many  important...  and  some- 
times literally  lifesaving  results  come 
about  from  this  testing.  Here  are 
excerpts  from  an  actual  letter  from 
one  of  the  9Health  Fair  participants 
last  year. 

John  (age  41)  says  that  because 
of  9Health  Fair  he  found  out  that  not 
only  was  his  blood  pressure  high, 
"but  so  was  my  blood  sugar.  I was 
diagnosed  (at  Inner  City  Health 
Center)  in  May  as  having  adult 
diabetes  and  severe  fluid  retention. 
Diet  and  medications  were  pre- 
scribed. I have  lost  80  pounds,  my 
blood  pressure  is  130/70  and  blood 
sugar  has  gone  from  291  to  1 39.  I'm 
off  the  medication  and  controlling 
my  diabetes  through  diet  alone.  I'm 
walking  1 -2  miles  every  morning, 
looking  good  and  feeling  great! 

I can't  tell  you  how  much  I 
appreciate  the  information  I received 
at  the  9Health  Fair.  I'm  a believer! 
Thanks  for  your  help." 

As  a member  of  the  Medical 
Advisory  Board...  I can  tell  you  that 
tests  like  blood  pressure  and  blood 
sugar  are  not  chosen  by  chance.  The 
9Health  Fair  staff  carefully  re- 
searches new  findings  and  preven- 
tive health  recommendations...  and 
assists  the  Medical  Board  in  updating 


our  screenings.  The  staff  makes  sure 
that  we  include  screenings  that  really 
make  a difference. 

I can  also  tel!  you  that  what  we 
decide  to  keep  out  of  the  health  fair 
is  equally  as  important  as  what  we 
recommend  goes  in.  Because  of  the 
phenomenal  success  of  the  9Health 
Fair,  many  groups  are  interested  In 
becoming  part  of  it...  so  they  can  be 
associated  with  a high-quality  and 
prestigious  organization. 

All  of  you  should  know  that 
Vicki  Godbey,  Linda  Manson  and 
their  staff  work  extremely  hard  ...  to 
make  sure  that  our  information  and 
screenings  are  as  scientific  and  up- 
to-date  as  is  humanly  possible. 

Clearly,  the  screenings  and 
testing  at  the  fairs  are  valuable  parts 
of  what  we  do. 

But  the  most  important  part  of 
the  fair  doesn't  need  a needle  or  a 
tube  of  blood.  It  doesn't  need  a 
vision  chart.  It  doesn't  need  a blood 
pressure  cuff  and  stethoscope.  It 
simply  needs...  a volunteer's  voice. 

The  learning  centers  at  the 
health  fairs  provide  the  means  to 
achieve  the  main  goal  of  our  organi- 
zation... to  help  people  take  better 
care  of  themselves. 

These  learning  centers  give 
people  information  about  how  to 
lower  their  risk  of  heart  attacks  and 
strokes...  how  to  avoid  risk  factors  for 
cancer...  and  how  to  get  into  healthy 
life-styles.  Screenings  and  learning 
centers  make  up  what  the  9Health 
Fair  does...  But  they  don't  make  up 
what  we  are. 

The  9Health  Fair  needs  more 
than  screenings  and  learning  centers 
to  run  effectively...  or  to  run  at  all.  It 
needs  the  commitment  of  people  like 


440 


Colorado  Medicine  for  December,  1993 


Colorado  Medical  Society,  for  the  fourth  year,  endorses  the  9Health  Fair,  held  state-wide  in  April.  In  our  commitment 
to  this  program,  CMS  contributes  by  informing  our  physician  members  and  encouraging  their  participation  in  the 
9Health  Fair. 


our  corporate  sponsors  who  under- 
stand that  the  power  of  knowledge  is 
stronger  than  the  most  powerful  CAT 
scan  machine.  It  needs  the  expertise 
of  the  Board  of  Trustees  and  Business 
Board  of  Advisors  who  realize  that  a 
health  problem  found  now  keeps 
people  healthier  later.  And  it  needs 
the  caring  of  people  like  Vicki 
Godbey  and  her  staff  who  know  how 
to  put  it  all  together  for  us  with  their 
organizational  skills. 

It's  a cliche  now  to  say...  "To- 
gether... We  can  make  a difference." 
But  you  and  I both  know  that  it's 
true.  Each  individual  can  truly  play 
an  important  role.  And  I want  to 
leave  you  with  a story  about  the 
power  of  the  individual. 

New  Jersey  Senator  Bill  Bradley, 
at  an  honorary  dinner  function,  was 
served  only  one  pat  of  butter.  The 
Senator  asks  for  a second  pat...  and 
the  waiter  said...  "Sorry...  Only  one 
pat  per  person.  Bradley  says... 
"Maybe  you  don't  know  who  I am." 
The  waiter  says  he  doesn't.  Bradley 
then  tells  the  waiter  all  his  accom- 
plishments: All-American  college 
basketball...  Rhodes  scholar...  NBA 
all-star  and  champion,  ending  with 
"Now  I'm  the  U.S.  Senator  from  New 
Jersey".  A pause  occurs  while  the 
waiter  soaks  up  all  that  information, 
and  then  the  waiter  says  "Well... 
maybe  you  don't  know  who  I am". 
"No...  who  are  you?"  asks  Bradley. 
The  waiter  responds...  "I'm  the  guy 
who's  in  charge  of  the  butter". 

Each  of  you  is  the  guy  with  the 
butter.  You're  the  ones  who  make 
the  9HealthFair  work.  Congratula- 
tions on  your  successes...  thank  you 
for  all  your  help...  and  good  luck  to 
all  of  you  this  coming  year. 


Ed.  note:  Dr.  Rob  Bogin  is  one  of 
four  CMS  members  involved  in  the 
9HealthFair  Medical  Advisory 
Committee.  The  others  are  Robert  B. 
Sawyer,  M.D.;  Eugene  Weston, 

M.D.;  Sherri  Laubach,  M.D. 

The  BHealth  Fairs  are  a non- 
profit organization,  held  state  wide 
in  the  first  week  of  April  and  en- 
dorsed by  the  Colorado  Medical 
Society  offering  free  health  education 
and  basic  health  screenings  to  the 
public.  The  only  charge  to  the 
participant  is  a nominal  fee  for  the 
optional  blood  chemistry  analysis. 
Medical  volunteers  are  needed  to 
perform  screenings  in  the  areas  of 
peripheral  arterial  disease,  hearing, 
prostate/testicular  cancer,  glaucoma, 
oral  cancer,  podiatry,  pap  smears, 
skin  cancer,  breast  exams,  and 
summary  and  referral. 

Summary  and  referral  is  a very 
important  aspect  where  the  partici- 
pant has  an  opportunity  to  speak 
with  a medical  professional  about 
their  health  history,  the  screenings 
performed  and  any  other  medical 
issues  of  concern. 

Each  year,  following  the  9Elealth 
Fairs,  Colorado  Medical  Society 
receives  a summary  of  the  statewide 
health  screening  and  education 
program.  This  summary  includes 
demographic  information  as  well  as 
follow-up  reports  on  a majority  of 
those  persons  about  who  there  was 
any  question  regarding  the  screening 
results.  Typically,  follow-up  contacts 
determined  that  the  person's  condi- 
tion was  I)  clearly  abnormal,  2)  that 
the  person  was  following  a phys- 
ician's advice  or,  3)  that  the  condi- 
tion was  questionable  and  clearly 
normal. 


Rob  Bogin,  M.  D. 


Dr.  Rob  Bogin,  a specialist  in 
pulmonary  medicine,  is  Medical 
Director  for  MetLife  Insurance 
Company.  He  serves  as  a CMS 
Alternate  Delegate  to  the  AMA,  is 
chair  of  the  CMS  Health  Systems 
Reform  Committee. 

Dr.  Bogin  also  appears  weekly 
on  KUSA-TV  Channel  9 "Good 
Afternoon  Colorado" with  a medi- 
cal information  program  segment, 
and  writes  a weekly  column  in  the 
Lifestyles  section  of  the  Sunday 
edition  of  the  Rocky  Mountain 
News. 


CMS  member  physicians  are 
urged  to  participate  in  local 
9Health  Fairs.  You  can  do  so  as  a 
volunteer  by  calling  Linda  Manson 
or  Kathy  Kennedy  at  the  9Health 
Fair  offices  at  (303)  698-4455  or 
by  calling  your  local  9Hea!th  Fair 
site  coordinator. 


Colorado  Medicine  for  December,  1993 


441 


he  New  Direction: 

A Report/Update  from  the  Colorado  Foundation  for  Medical  Care 


by  Thomas  R.  Dunn , M.D. 


As  was  announced 
earlier  this  year ; the 
Health  Care  Financing 
Administration  (HCFA)  is 
reshaping  its  approach  to 
improving  care  for  Medi- 
care beneficiaries. 


Thomas  R.  Dunn , M.  D.  Medical 
Director,  Colorado  Toundation  for 
Medical  Care,  is  a Pediatrician  with 
the  Greeley  (Colorado)  Medical 
Clinic. 


Photo  by  Gil  Maestas,  II 


Under  the  Fourth  Scope  of 
Work  (SOW)  begun  by  Colorado 
Foundation  for  Medical  Care  (CFMC) 
on  April  1 , 1 993,  the  stated  goal  is  to 
move  from  dealing  with  individual 
clinical  errors  to  helping  providers  to 
improve  the  mainstream  of  care.  This 
has  required  significant  changes,  the 
most  important  of  which  are  signifi- 
cant reduction  in  individual  case 
review  and  punitive  aspects  of  the 
program,  from  use  of  intuitive  local 
criteria  to  more  explicit  nationally 
uniform  guidelines,  and  strong 
emphasis  on  pattern  analysis  and 
education.  The  Peer  Review  Organi- 
zation (PRO)  is  to  focus  on  persistent 
differences  between  observed  and 
achievable  in  both  care  and  out- 
comes. The  ultimate  change  is  to 
help  physicians,  hospitals  and 
managed  care  organizations  identify 
problems  and  solutions  by  monitor- 
ing care  and  outcome  patterns,  and 
then  allow  providers  to  conduct  the 
in-depth  study  of  who,  when,  and 
why. 

In  the  Fourth  SOW,  gone  are  the 
numerical  designations  of  quality 
concerns  (Level  I,  II,  and  III)  with 
prescribed  interventions  for  each. 
With  this  change  in  interventions, 
CFMC  has  dispensed  with  its  State- 
wide Quality  Assurance  Committee. 
Instead,  when  a pattern  of  concerns 
or  interest  is  identified  (best  practices 
or  variations)  cooperative  projects 
may  be  initiated  on  either  a local  or 
statewide  basis.  This  new  direction  is 
referred  to  as  the  FHealth  Care 
Quality  Improvement  Initiative 
(HCQII). 

CFMC  now  works  with  hospital 
administrations  and  medical  staffs  on 
a variety  of  national  and  PRO- 


initiated  cooperative  projects.  The 
cooperative  part  of  this  process  refers 
to  working  together  of  staffs,  physi- 
cians, reviewers,  researchers,  pattern 
analyst,  database  managers,  epide- 
miologists and  others  as  needed.  The 
process  is  based  on  the  principles  of 
continuous  quality  improvement  and 
variation  analysis  and  uses  informa- 
tion derived  from  case  review, 
quality  and  utilization  profiling, 
pattern  analysis  and  national/PRO 
initiated  projects.  Appropriate 
periodic  feedback  of  information 
developed  by  these  projects  to  the 
providers  is  an  important  link  in  this 
process.  Monitoring  of  the  effects 
and  usefulness  of  the  FHCQII  projects 
is  another  important  component  of 
the  methodology. 

The  Principal  Coordinator  of  the 
HCQII  at  the  CFMC  is  Bonnie 
McCafferty,  M.D.,  M.S.P.H,  with 
Dennis  Waite,  M.D.,  as  Assistant 
Coordinator.  In  addition,  we  have 
increased  our  staff,  computer 
capability  and  technical  training  to 
assist  in  this  changed  environment. 

An  essential  requirement  of 
HCQII  is  to  establish  and 
operationalize  a Steering  Committee 
consisting  of  physicians,  health  care 
administrators,  nurses,  quality 
assurance/improvement  profession- 
als, health  service  researchers,  and 
consumers.  This  committee  actively 
oversees  local  and  national  projects 
and  provides  advice  on  the  prioritiz- 
ing, conduct,  assessment  and 
benefits  of  each  project.  Another 
function  of  this  committee  is  to  bring 
together  an  appropriate  study  group 
for  each  project  and  to  provide 
ongoing  advice  for  each  study  group 
as  well  as  HCQII  staff. 


442 


Colorado  Medicine  for  December,  1993 


The  function  of  the  study  group 
is  to  transform  the  issue  into  a 
working  hypothesis,  develop  the 
study  group  design  and  project  the 
measurablke  outcome.  One  of  the 
principle  and  most  important  roles  of 
this  group  is  defining  an  educational 
strategy  for  dissemination  or  diffu- 
sion of  the  study  findings,  and 
developing  an  evaluation  instrument 
to  measure  impact. 

At  this  time,  four  projects  have 
been  authorixed  by  the  CFMC  HCQII 
Steering  Committee: 

1 . Quality  concerns  at  one  institution 

2.  Back  and  neck  surgery 

3.  Medication  errors 

4.  Carotid  endarterectomy 


Study  groups  have  been  con- 
vened and  are  beginning  work  on 
these  issues.  The  carotid 
endarterectomy  project  is  a collabo- 
rative study  with  three  other  state 
PROs  - Commecticut,  Georgia  and 
Virginia  in  conjunction  with  the 
Thomas  Jefferson  Health  Policy 
Institute  and  the  University  of 
Virginia.  Additionally,  the  Arizona 
PRO  has  asked  for  data  relative  to 
Colorado's  Medicare  Prostatectomy 
data  and  while  we  are  not  proceed- 
ing with  a study  in  this  area,  the  data 
is  to  be  shared  with  Rocky  Mountain 
Urologic  Society  for  information. 

These  are  examples  of  the  topics 
b;eing  developed  through  use  of 
CFMC  data  as  well  as  other  available 


data  sources  for  evaluation  as 
potential  cooperative  projects.  This 
focus  is  proving  to  be  very  exciting 
and  has  been  well  received  by  the 
provider  population.  A brief  periodic 
information  newsletter  titled 
"Updata"  is  produced  by  the  CFMC 
staff  and  distributed  to  interested 
individuals  and  institutions  to  report 
on  the  activities  related  to  the  Health 
Care  Quality  Improvement  Initiative. 
To  promote  this  new  look,  Dr. 

Robert  Keller,  the  Director  of  the 
Maine  Medical  Assessment  Founda- 
tion, shared  his  extensive  insight  and 
experience  with  the  CFMC  Board  of 
Directors,  CMS  and  CHA  leadership, 
physician  reviewers  and  membership 
at  the  CFMC  Annual  Meeting  held  in 
October. 


A child  cries  for  food. 
We  doctors  must 
answer. 

World  hunger  is  an 
ever-present  scourge 
that  claims  35,000  lives 
each  day. 

Physicians  Against  World 
Hunger  (PAWH),  is  a non-profit, 
tax-exempt  organization, 
founded  by  physicians  to  defend  the  basic  human 
right  to  food.  In  partnership  with  well  recognized 
and  reputable  organizations  PAWH  supports 
hunger  projects  throughout  the  world. 

Together  physicians  must  bring  an  end  to  world 
hunger.  We  are  sworn  to  protect  human  life.  When 
people  dying  of  hunger  cry  out  for  help,  we  must 
respond.  — Please  join  us. 


Physicians  Against  World  Hunger 

#2  Stowe  Rood,  Peekskill,  NY  1 0566  (914)  737-8570 

YES  I wish  to  join  PAWH  in  the  struggle  to  end  world  hunger 
— enclosed  is  my  contribution. 

□ $50  a $1 00  □ $250  □ $500  □ Other 


NAME  PLEASE  PRINT 


ADDRESS 


CITY  STATE  ZIP 


SIGNATURE 

Please  forward  your  tax  deductible  contribution  to 

Physicians  Against  World  Hunger 

# 2 Stowe  Road,  Peekskill,  NY  1 0566 


Colorado  Medicine  for  December,  1993 


443 


O.S.H.A.  News 


In  a ten  month  period 
OSHA  issued  3,065 
citations.  Read  and  avoid 
these  violations. 


A year  and  a half  has  passed  since 
the  OSHA  Bloodborne  Pathogen 
Standard  went  into  effect  — enough 
time  to  allow  for  the  collection  and 
analysis  of  a variety  of  data.  A 
Boulder-based  bimonthly  newsletter, 
Bloodborne  Pathogen  Update,  has 
recently  begun  reporting  just  such 
data.  Specific  information  which  can 
be  found  in  the  Update  includes:  a 
list  of  violations  that  have  occurred 
and  their  associated  penalties, 
common  problems  noted  by  OSHA 
consultants  along  with  recom- 
mended solutions,  recent  official 
interpretations  and  OSHA  informa- 
tion and  products  which  have 
become  available  by  phone. 

The  following  information  was 
reprinted  with  permission  from  the 
Update. 

Types  of  Violations  and 
Their  Associated 
Penalties 

Enforcement  data  on  the  OSHA 
Bloodborne  Pathogen  Standard  was 
collected  and  analyzed  for  the  ten 
month  period  between  July  1992  and 
April  1993.  During  that  period, 
OSHA  issued  3,065  citations.  There 
were  2,273  serious  violations 
however,  only  36  were  considered 
willful  violations.  The  maximum 
final  penalty  for  any  single  citation 
was  $1,1  27.  The  average  final 
penalty  was  $1  66  per  citation. 

The  five  most  frequently  cited 
sections  were: 

— c(1)i:  491  citations  for  failing  to 
create  an  exposure  control  plan. 
The  average  final  penalty  was 
$313. 

— g(2)i:  375  citations  for  failing  to 
train  exposed  employees.  The 


average  final  penalty  was  $223. 

— f(2)i:  1 84  citations  for  not  offering 
hepatitis  B vaccinations.  The 
average  final  penalty  was  $1  33. 

— c(1)ii(B):  1 33  citations  for  not 
having  an  implementations 
schedule.  The  average  final 
penalty  was  $1  77. 

— f ( 2 ) i v : 93  citations  for  not  having 
signed  declination  forms  for  all 
employees  not  vaccinated.  The 
average  final  penalty  was  $67. 

The  five  sections  with  the 
highest  average  fines  were: 

— d(3)iii:  27  citations  for  failure  to 
have  personal  protective  equip- 
ment accessible  produced  average 
fines  of  $1,127. 

— h(1 ):  3 citations  for  not  maintain- 
ing medical  records  produced 
average  fines  of  $1 ,1 1 0. 

- — g(2)ix:  1 citation  for  not  providing 
the  additional  training  required  for 
HIV/HBV  labs  resulted  in  a $935 
fine. 

— f(2)v:  1 citation  for  not  providing  a 
HBV  booster  produced  an  $875 
fine. 

— f(4)ii(C):  1 citation  for  not  provid- 
ing the  necessary  medical  records 
after  an  exposure  incident  pro- 
duced an  $875  fine. 

The  three  sections  with  the 
highest  percentage  of  citations  for 
willful  violations: 

— g(2)vii(C):  25%  of  the  citations  for 
failure  to  provide  training  in  modes 
of  disease  transmission. 

— d(4)iii(A)1 : 1 5%  of  the  citations 
for  failing  to  rapidly  dispose  of 
sharps  containers. 

— d(3)viii:  1 4%  of  the  citations  for 
failing  to  put  laundry  in  appropri- 
ate containers. 


444 


Colorado  Medicine  for  December,  1993 


Enforcement  Data 
Official  Interpretations 
Common  Problems  and  Their  Solutions 


by  Lynn  Livingston 
Health  Care  Policy  Department 


Hospitals  and  nursing  homes 
accounted  for  60%  of  the  inspections 
during  the  ten  month  period.  Fewer 
than  9%  of  the  inspections  were  at 
medical  clinics.  Inspections  at  the 
larger  facilities  such  as  hospitals  are 
generally  scheduled.  Inspections  at 
smaller  facilities  are  usually  the 
result  of  an  employee  complaint. 

Note:  Large  dollar  citations  can 
be  avoided  by:  1 ) providing  employ- 
ees with  the  right  personal  protective 
equipment  when  and  where  it  is 
needed,  and  2)  maintaining  all 
required  medical  records. 

Recent  Interpretations  of 
the  Bloodborne  Pathogen 
Standard 

OSHA  has  issued  over  100  official 
interpretations  of  the  Standard  since 
the  it  became  effective  in  March  of 
1992.  These  interpretations  may 
affect  the  way  you  implement  the 
standard.  Two  recent  official  inter- 
pretations follow. 

1.  In  a June  memo,  the  OSHA 
Director  of  Compliance  Programs 
stated  that  disinfectants  registered 
with  the  EPA  as  effective  against  TB 
will  be  acceptable  for  the  Blood- 
borne  Pathogen  Standard.  OSHA 
assumes  that  a product  effective 
against  TB  will  also  be  effective 
against  HIV-1  and  that  HIV-1  label 
claims  are  not  needed  for  compli- 
ance with  the  Bloodborne  Pathogen 
Standard.  This  is  a change  from 
OSHA's  previous  instructions  which 
implied  that  HIV-1  labeling  was 
needed  in  addition  to  TB  labeling. 

2.  Another  OSHA  memo  stated 
that  the  organization  encourages,  but 
does  not  require  an  employer  to 
launder  an  employee's  contaminated 


personal  clothing.  The  compliance 
impact:  Develop  a procedure  for 
dealing  with  contaminations  of 
personal  clothing.  The  procedure 
should  include  cleaning  of  the 
clothing  and  an  evaluation  of  the 
reason  for  the  contamination. 
Personal  protective  equipment  (PPE) 
should  be  evaluated.  Determine 
whether  the  problem  is  inadequate 
PPE  or  simply  a one-time  failure. 

Consultants  Offer  Advice 
on  Common  Problems 

Consultants  who  frequently  audit 
bloodborne  pathogen  control 
programs  have  provided  recommen- 
dations on  several  common  prob- 
lems. 

The  first  common  problem  noted 
by  consultants  was  that  disinfectants 
are  often  not  clearly  identified. 
Exposure  control  plans  should  list  the 
EPA  registration  number  and  exact 
name  of  the  disinfectants  used.  Also 
users  should  check  to  make  sure  that 
the  disinfectant  is  at  least  TB  active. 

Secondly,  the  consultants 
advised  that  the  exposure  control 
plan  ought  to  include  scheduled 
inspections  of  sharps  and  other  waste 
containers.  Inspections  should  occur 
before  every  shift  to  make  sure  that 
personal  protective  equipment  is 
available  where  needed.  Individuals 
should  be  assigned  responsibility  for 
these  inspections. 

A third  problem  frequently 
encountered  by  consultants  was 
unsafe  sharps  containers.  Sharps 
containers  should  be  secured  and 
away  from  the  reach  of  children. 

OSHA  Information  and 
Products  Available  By 


Phone 

The  following  products  and 
information  which  were  designed  to 
help  organizations  comply  with  the 
Bloodborne  Pathogen  Standard  are 
available  by  phone: 

1 . The  EPA  is  in  the  process  of 
testing  all  registered  sterilants  and 
disinfectants  in  order  to  verify  their 
effectiveness.  An  antimicrobial 
hotline  has  been  established  by 
Texas  Tech  to  confirm  the  latest 
information  about  sterilants  and 
disinfectants.  The  hotline  number  is 
1-800-447-6349. 

2.  A toll-free  helpline  to  provide 
information  about  the  Bloodborne 
Pathogen  Standard  is  operated  by 
Kimberly-Clark.  The  number  is  1- 
800-524-3577. 

3.  The  Service  Employees 
International  Union  have  developed 
a needlestick  prevention  factpack 
which  includes  evaluations  of 
several  sharps  container  systems  and 
needle  systems.  To  obtain  a copy 
call  202-898-3386. 

4.  An  inexpensive  recapping 
tool  is  being  sold  by  SafeCap  Inc. 

Call  1-800-584-5553  for  infor- 
mation. 

Other  OSHA  News 

-The  sale  of  the  entire  Wipeout 
product  line  of  disinfectants  was 
stopped  by  the  EPA  on  May  1 8, 

1 993.  The  EPA  determined  that  the 
Wipeout  products  do  not  kill  listed 
pathogens  when  used  according  to 
label  directions.  Therefore,  if  you 
have  Wipeout  disinfectants  don't 
use  them. 

To  order  the  Bloodborne  Patho- 
gen Update  write:  David  Hustvedt, 
Editor,  967  Poorman  Road,  Boulder, 
Colorado 80302  orcall  800-334-1213. 


Colorado  Medicine  for  December,  1993 


445 


Definitions 


The  definition  of  terms  in  health  care  financing  and  of  terms  related  to  delivery,  provision  and 
evaluation  of  care.  Colorado  Medicine  suggests  you  keep  these  monthly  articles  and  definitions, 
even  though  many  will  change,  some  will  disappear  and  new  ones  will  appear  as  the  health  system 
reform  unfolds. 


TERMS  RELATED  TO  FINANCING 
HEALTH  CARE 

□ PREMIUM  -The  amount  of  money 
or  consideration  which  is  paid  by  an 
insured  person  or  policy  holder  (or 
on  his  behalf)  to  an  insurer  or  third 
party  for  insurance  coverage  under 
an  insurance  policy.  The  premium  is 
generally  paid  in  periodic  amounts. 

It  is  related  to  the  actuarial  value  of 
the  benefits  provided  by  the  policy, 
plus  a "loading"  to  cover  administra- 
tive costs,  profit,  etc.  Premium 
amounts  for  employment  related 
insurance  are  often  split  between 
employers  and  employees.  Premi- 
ums are  paid  for  coverage  whether 
benefits  are  actually  used  or  not; 
they  should  not  be  confused  with 
cost-sharing,  like  co-payments  and 
deductibles  which  are  paid  only  if 
benefits  are  actually  used. 

[_)  PROVIDER-An  individual  or 
institution  which  gives  medical  care. 

Q RISK-Generally,  a chance  of  loss. 
In  insurance,  designates  the  indi- 
vidual or  property  insured  by  an 
insurance  policy  against  loss  from 
some  peril  or  hazard. 

TERMS  RELATED  TO  DELIVERY  OF 
CARE 

□ ACCESS  TO  CARE-An 

individual's  (or  group's)  ability  to 
obtain  medical  care.  Access  has 
geographic,  financial,  social,  ethnic 
and  psychic  components  and  is  thus 
very  difficult  to  define  and  measure 
operationally.  Many  government 
health  programs  have  as  their  goal 
improving  access  to  care  for  specific 


groups  or  equity  of  access  in  the 
whole  population.  Access  is  also  a 
function  of  the  availability  of  health 
services,  and  their  acceptability.  In 
practice  access,  availability  and 
acceptability,  which  collectively 
describe  the  things  which  determine 
the  care  people  use,  are  very  hard  to 
differentiate. 

□ COMMUNITY  HEALTH  CENTER- 

An  ambulatory  health  care  program 
usually  serving  a catchment  area 
with  scarce  or  non-existent  health 
services  or  a population  with  special 
health  needs.  Often  known  as 
neighborhood  health  centers.  These 
centers  attempt  to  coordinate 
Federal,  State,  and  local  resources  in 
a single  organization  capable  of 
delivering  both  health  care  and 
related  social  services  to  a defined 
population.  Other  ambulatory 
centers  providing  health  services  in 
areas  of  medical  underservice 
include  family  health  centers  and 
community  health  networks.  While 
such  centers  may  not  directly 
provide  all  types  of  health  care,  they 
usually  take  responsibility  for 
arranging  for  all  medical  services 
needed  by  their  patients. 

□ CONCURRENT  REVIEW-Review 

of  the  medical  necessity  of  hospital 
and  other  health  facility  admissions 
upon  or  within  a short  period 
following  an  admission  and  the 
periodic  review  of  services  provided 
during  the  course  of  treatment.  The 
initial  review  usually  assigns  an 
appropriate  length  of  stay  to  the 
admission  (using  diagnosis  specific 
criteria)  which  may  also  be  reas- 
sessed periodically.  When  concur- 


rent review  is  required,  payment  for 
unneeded  hospitalizations  or 
services  is  usually  denied.  Concur- 
rent review  should  be  contrasted 
with  a retrospective  medical  audit, 
which  is  done  for  quality  purposes 
and  does  not  relate  to  payment,  and 
claims  review,  which  occurs  after 
the  hospitalization  is  over. 

□ GROUP  MODEL  HEALTH 
MAINTENANCE  ORGANIZATION 
(HMO)-  A group  model  FHMO 
contracts  with  clinics.  They  may 
pay  the  clinic  a fixed  amount, 
monthly,  based  on  the  number  of 
patients  who  have  designated  that 
clinic  as  their  provider.  The  burden 
for  controlling  utilization  falls  on 
the  physician,  and  the  physician 
will  receive  no  additional  money  if 
utilization  exceeds  projections. 

□ HEALTH  CARE  DELIVERY 

SYSTEM-An  organization  or  ar- 
rangement that  provides  for  the 
delivery  and  financing  of  health 
care  services.  These  may  include 
traditional  indemnity  insurance, 
health  maintenance  organizations, 
preferred  provider  organizations, 
and  competitive  medical  plans. 

Also  included  would  be  the  Medi- 
care and  Medicaid  programs. 

□ HEALTH  MAINTENANCE 
ORGANIZATION  (HMO)-An  entity 
that  provides  or  arranges  for  the 
provision  of  a comprehensive  range 
of  basic  and  supplemental  health 
care  services  to  voluntarily  enrolled 
persons  in  a geographic  area,  in 
exchange  for  a premium  fee. 

HMOs  may  be  divided  into  three 
basic  types,  (group,  staff  and  IPA) 


446 


Colorado  Medicine  for  December,  1993 


depending  on  the  physician's 
relationship  to  the  HMO. 

□ INDEMNITY  INSURANCE- 

Traditional  coverage  offered  by 
insurance  companies,  wherein  the 
patient  or  the  provider  is  directly 
reimbursed  after  the  medical  en- 
counter occurs. 

□ INDEPENDENT  PRACTICE 
ASSOCIATION  (IPA)  MODEL  HMO- 

An  IPA  model  may  contract  with 
individual  practice  associations  or 
individual  physicians,  either  on  a 
capitated  or  fee-for-service  basis, 
with  a risk  withhold  and  a maximum 
fee  schedule. 

□ MANAGED  HEALTH  CARE-A 

prepaid  health  plan  or  insurance 
program  where  beneficiaries  receive 
medical  services  in  a coordinated 
manner  so  as  to  eliminate  unneces- 
sary medical  services.  In  managed 
care  health  plans,  the  beneficiary  is 
not  permitted  to  seek  specialty 
hospital  care  without  prior  approval 
of  designated  health  care  profession- 
als, such  as  primary  care  physicians, 
utilization  review  nurses,  or  em- 
ployer designated  professionals. 

MANAGED  SERVICE  ORGANIZA- 
TION (MSO)  An  MSO  combines  the 
features  of  a group  practice  and 
those  of  a contracting  body.  Struc- 
tured around  key  services  that  are 
essential  to  a physician  practice,  an 
MSO  can  take  the  form  of  a hospital- 
sponsored  business  or  one  which 
involves  physician  equity  positions. 
Key  MSO  services  include  overall 
management  and  consultative 
practice  reviews,  billing  and  collec- 
tion, equipment  and  personnel 
pooling,  risk  management  and 
recruiting. 

□ PREFERRED  PROVIDER  ORGA- 
NIZATION (PPO)-A  term  applied  to 
a variety  of  direct  contractual 
relationships  between  hospitals, 
physicians,  insurers,  employers,  or 
third  party  administrators  in  which 
providers  negotiate  with  group 
purchasers  to  provide  health  services 
for  a defined  population,  and  which 
typically  share  three  characteristics: 


(1)  A negotiated  fee  system  of  pay- 
ment for  services  that  may  include 
discounts  from  usual  charges  or 
ceilings  imposed  on  a charge,  per 
diem,  or  per  discharge  basis. 

(2)  Financial  incentives  for  individual 
subscribers  (insureds)  to  use  con-  I 
tracting  providers,  usually  in  the 
form  of  reduced  co-payments  and 
deductibles,  broader  coverage  of 
services,  or  simplified  claims  pro- 
cessing. 

(3)  An  extensive  utilization  review 
program. 

□ PRIMARY  CARE  PHYSICIAN- 

Usually  a general  practitioner,  family 
physician,  internist,  obstetrician,  or 
pediatrician  who  provides  basic 
health  care.  A primary  care  physi- 
cian is  usually  seen  when  a patient 
first  seeks  assistance  and  may  act  as 
a "gatekeeper"  by  controlling  the  use 
of  other  health  care  services. 

□ RETROSPECTIVE  REVIEW- 

Review  of  claims  by  governments, 
medical  foundations,  Peer  Review 
Organizations  (PROs),  insurers  or 
others  responsible  for  payment  to 
determine  liability  and  amount  of 
payment.  This  review  may  include 
determination  of  the  eligibility  of  the 
claimant  or  beneficiary;  of  the 
eligibility  of  the  provider  of  the 
benefit;  that  the  benefit  for  which 
payment  is  claimed  is  covered;  that 
the  benefit  is  not  payable  under 
another  policy;  and  that  the  benefit 
was  necessary  and  of  reasonable  cost 
and  quality. 

□ SPECIALTY  PHYSICIAN-A 

physician  or  other  health  profes- 
sional who  limits  his  practice  to  a 
certain  branch  of  medicine  related 
to  specific  services  or  procedures, 
e.g.,  surgery,  radiology,  pathology; 
certain  age  categories  of  patients, 
e.g.,  pediatrics,  geriatrics;  certain 
body  systems,  e.g.,  dermatology, 
orthopedics,  cardiology;  or  certain 
types  of  diseases,  e.g.,  allergy, 
psychiatry.  Specialists  usually  have 
special  education  and  training 
related  to  their  practice  and  may  or 
may  not  be  certified  as  specialists  by 
the  related  specialty  board. 


□ STAFF  MODEL  HMO-A  staff 
model  employs  physicians  and  has 
them  on  salary.  This  is  simply  an 
employee/employer  relationship. 

TERMS  RELATED  TO  PROVIDING 
CARE 

□ ACUTE  CARE-Care  which  is 
characterized  by  a single  episode  of 
a fairly  short  duration  from  which  the 
patient  returns  to  his  normal  or 
previous  state  and  level  of  activity.  It 
is  worth  noting  that  an  acute  episode 
of  a chronic  disease  is  often  treated 
as  an  acute  disease. 

□ AMBULATORY  CARE-AII  types  of 
health  services  which  are  provided 
on  an  outpatient  basis,  in  contrast  to 
services  provided  in  the  home  or  to 
persons  who  are  inpatients.  While 
many  inpatients  may  be  ambulatory, 
the  term  ambulatory  care  usually 
implies  that  the  patient  has  come  to 

a location  other  than  his  home  to 
receive  services  and  has  departed  the 
same  day. 

□ ANCILLARY  SERVICES-Hospital, 

or  other  inpatient  health  programs, 
services  other  than  room  and  board, 
and  professional  services.  They  may 
include  x-ray,  drug,  laboratory  or 
other  services  not  separately  item- 
ized, but  the  specific  content  is  quite 
variable. 

Q CHRONIC  CARE-Care  of  diseases 
which  have  one  or  more  of  the 
following  characteristics;  are  perma- 
nent; leave  residual  disability;  are 
caused  by  nonreversible  pathological 
alteration;  require  special  training  of 
the  patient  for  rehabilitation;  or  may 
be  expected  to  require  a long  period 
of  supervision,  observation  or  care. 

□ CONCURRENT  CARE-The 

provision  of  medical  care  to  one 
patient,  during  the  same  span  of 
illness,  by  more  than  one  physician 
of  different  or  similar  specialties. 


(Will  be  continued  next  month ) 


Colorado  Medicine  for  December,  1993 


447 


ecisions  that  pay  off 


by  Bill  Pierson,  Director 
CMS  Member  Services 


If  you're  writing  off  even  a 
small  amount  each  year ; 
you're  working  harder 
than  necessary. 


When  it  comes  time  to  talk 
about  collecting  bad 
debts,  especially  when 
this  concerns  a doctor-patient 
relationship,  physicians  simply  can't 
bring  themselves  to  even  discuss 
traditional  methods  of  ...collections. 
Even  uttering  the  word,  "collections" 
automatically  produces  that  mental 
bad  taste,  because  there's  just  no 
other  subject  that  interferes  more 
with  good  doctor-patient  relations. 
Some  Colorado  Medical  Society 
members  may  just  be  writing  off  bad 
debts.  Others  may  be  doing  in-house 
collections.  Still  others  use  collection 
agencies. 


Colorado  Medical  Society  has 
endorsed  I.  C.  System  for  12  years. 
CMS  has  examined  many  other 
agencies  and  has  found  none  which 
provides  the  services  that  come  with 
I.  C.  System.  Yes,  there  have  been 
complaints,  but 
very  few  over  a 
twelve  year 
period.  And 
every  com- 
plaint that 
reaches  the 
Member  Services  office  is  investi- 
gated and  reported  to  the  I.  C. 

System  management,  with  instruc- 
tions that  a follow-up  report  be  given 
this  office,  indicating  the  action 
taken. 

Now  that  we've  broken  the  ice 
by  saying  "collection",  here  are 
some  things  to  keep  in  mind  when 
you're  considering  what  to  do  about 
your  past  due  accounts.  Your 
choices  can  affect  your  payoff. 

If  you're  writing  off  even  a small 
amount  each  year,  you're  working 
harder  than  necessary.  Trying  to 
replace  money  written  off  while 
simultaneously  trying  to  maintain 
and  increase  business  is  like  patting 
your  head  and  rubbing  your  stomach 
at  the  same  time!  A business  which 
operates  at  a ten  percent  profit 
margin  and  writes  off  $2,000  in  a 
given  year  would  have  to  generate 
$20,000  in  brand  new  additional 
business  just  to  stay  even. 

Successful  businesses  which  do 
in-house  collections  realize  that 
there  comes  a time  when  continued 
efforts  to  collect  are  counterproduc- 
tive. Office  personnel  assigned 
collection  duties  generally  have 
other  primary  responsibilities.  The 


key  to  smart  accounts  receivable 
management  is  to  realize  that 
pursuing  past  due  accounts  after  two 
or  three  months  is  more  costly  than 
effective. 

What  can  you,  as  a CMS  mem- 
ber, expect  if  you  decide  to  use  a 
collection  agency?  You  get  a third 
party  which  enters  the  picture  and 
applies  proven,  professional  collec- 
tion techniques  on  your  behalf.  You 
get  experts::  people  who  know  the 
law  and  have  an  answer  for  every 
excuse  and  delaying  tactic  your 
debtor  might  use.  In  addition,  your 
collection  agency  has  no  personal 
relationship  at  stake  and  will  stay 
focused  on  the  job  at  hand. 

No  one  collection  agency  is  best 
for  everyone,  everywhere,  all  the 
time;  however,  200  CMS  members 
are  using  I.  C.  System  and  seeing 
positive  results.  In  fact,  members  in 
Cortez,  Denver  and  Gunnison  have 
each  added  over  $40,000  to  their 
bottom  lines  using  I.  C.  System.  The 
company  has  recovered  $1 56,000 
for  a member  in  Lakewood  and 
$167,000  for  another  member  in 
Grand  Junction.  Each  of  those 
members  made  a policy  decision  to 
work  in  partnership  with  a collection 
agency.  Each  one  selected  I.  C. 
System. 

If  you've  been  writing  off 
delinquent  accounts,  or  doing  your 
own  collections,  it  may  be  time  for  a 
change. 

To  learn  more,  call  Colorado 
Medical  Society  and  ask  for  Bill 
Pierson  in  Member  Services.  Your 
payoff  is  in  your  decision. 

C/M 


448 


Colorado  Medicine  for  December,  1993 


CMS  member  Fellow  of 
ACPM 

James  J.  Simerville,  MD  of  Colorado 
Springs  has  been  accepted  as  a 
Fellow  of  the  American  College  of 
Preventive  Medicine,  according  to 
Hazel  Keimowitz,  ACPM  Executive 
Director.  Ms.  Keimowitz  said  that 
this  meant  Dr.  Simerville  had 
"demonstrated  significant  commit- 
ment to  and  achievement  in  the  field 
of  preventive  medicine." 

Dr.  Simerville  practices  Occupa- 
tional and  Sports  Medicine  in 
Colorado  Springs  and  is  Medical 
Director  of  the  Colorado  Springs 
Medical  Center.  He  has  been  a 
member  of  the  Colorado  Medical 
Society  since  1 984. 

Lay  Midwifery  Outcomes 
Reporting 

The  rules  regarding  lay  midwifery 
have  been  finalized  by  the  Board  of 
Nursing  and  approved  by  the 
Attorney  General's  Office.  The  rules 
will  be  published  by  the  Secretary  of 
State  on  December  1 0 in  the  Code  of 
Colorado  Regulations.  The  Board  of 
Nursing  will  be  utilizing  temporary 
rules  to  allow  for  exam  registration  in 
the  interim.  The  first  exam  will  be 
given  on  December  14,  1993,  and 
registration  of  those  passing  the 
exam  will  be  completed  by  January 
1,1994. 

Included  in  the  rules  are  the 
guidelines  for  filing  complaints 
against  the  lay  midwives.  The  Board 
of  Nursing  will  be  regulating  the  lay 
midwives  per  1993  legislation. 
Physicians  have  been  asked  to  report 
all  outcomes  with  which  the  physi- 
cians become  involved.  This 
includes  involvement  prompted  by 
complications  and/or  outcomes 


Medical 


News/Inside  CMS 


whether  they  result  in  fetal  or 
maternal  death  or  a successful 
delivery.  Filing  a complaint  will 
follow  the  same  procedures  as  if  the 
complaint  were  against  a nurse. 
Complaints  can  be  made  by  contact- 
ing the  Board  of  Nursing  at  (303) 
894-2437. 

A summary  of  the  rules  regarding 
lay  midwifery  registration  will  be 
included  in  the  January  edition  of 
Colorado  Medicine. 

Are  You  Concerned 
About  A Situation 
Involving  Prescription 
Drug  Abuse? 

Information  on  existing  resources 
is  now  available  through  The 
Prescription  Drug  Abuse  Hotline 

(303)  893-9112.  The  hotline  is 
staffed  by  pharmacists  organized  to 
assist  professionals  in  dealing  with 
situations  related  to  prescription  drug 
abuse. 

The  Prescription  Drug  Abuse 
Hotline  is  a cooperative  effort  of  the 
Colorado  Prescription  Drug  Abuse 
Task  Force,  the  Colorado  Depart- 
ment of  Health  Alcohol  and  Drug 
Abuse  Division,  and  the  Rocky 
Mountain  Drug  Consultation  Cen- 
ters. 

Interim  Meeting  '94 

Mark  your  calendars  now  and 
plan  to  attend  the  Interim  Meeting 
March  5-6,  1994,  at  the  Sheraton 
DTC  Hotel.  Look  for  registration  and 
hotel  reservation  forms  in  the  next 
two  issues  of  Colorado  Medicine. 

For  the  first  time,  the  Hyatt 
Regency  at  Beaver  Creek  will  host 
our  Annual  Meeting.  September  8- 
11,1 994,  are  the  days  to  circle  on 
your  calendar. 


The  Committee  on  Accredita- 
tion, chaired  by  L.  H.  Stahlgren,  MD, 
met  Thursday,  November  4.  The 
Colorado  Society  of  Anesthesiolo- 
gists, Colorado  Permanente  Medical 
Group,  and  St.  Joseph  Hospital 
(Denver)  were  approved  for  re- 
accreditation. The  Committee 
discussed  recent  House  of  Delegates 
actions  specifically  affecting  the 
Committee,  i.e.,  how  the  Accredita- 
tion Program  can  become  financially 
self  sufficient  by  October  1 , 1 994. 
Each  member  was  charged  to  bring 
two  ideas  to  the  February  3 meeting: 

1 ) a way  to  achieve  financial  self 
sufficiency  and  2)  a way  to  cut 
existing  costs. 

The  Council  on  Professional 
Education  met  for  the  last  time 
November  5 to  transmit  to  the  Board 
the  Council's  suggestions  concerning 
functions  of  the  Council  that  should 
not  be  lost  as  a result  of  its  sunset. 
Council  members  support  continuing 
the  Accreditation  Program  even  if  it 
is  not  completely  financially  self 
sufficient  by  10/1/94;  continuing  to 
have  the  Annual  Meeting  Educa- 
tional Program  certified  for  CME 
credit;  increasing  the  number  of 
educational  programs  presented  by 
CMS  to  respond  to  the  changes  in 
the  healthcare  environment;  and 
considering  collaboration  with  CPEP 
and  the  University  to  evaluate  and 
address  rural  physician  educational 
needs.  The  Council  suggests  that 
these  recommendations  could  be 
accomplished  by  1 ) expanding  the 
charge  and  membership  of  the 
Committee  on  Accreditation  and 
changing  its  name  to  reflect  this;  or 

2)  establishing  an  ad  hoc  educational 
advisory  committee  reporting  to  the 
Health  Affairs  Council  or  the  Board 
of  Directors. 


Colorado  Medicine  for  December,  1993 


449 


A 


W.  George  Shanks,  M.D. 
Grand  Junction,  CO 


n open  letter 

I am  proud  to  be  a physician! 


W.  George  Shanks,  M.D. 

Dr.  Shanks  is  a General 
Surgeon  who  practices  in 
Grand  Juncion,  Colorado.  He 
is  a member  of  the  CMS  Board 
of  Directors.. 

Dr.  Shanks  received  his 
Degree  in  Medicine  from 
Temple  University  in  Philadel- 
phia, and  interned  in  Denver. 
He  also  did  his  residency  at  St. 
Joseph's  Hospital  in  Denver. 
He  has  been  a member  of 
Colorado  Medical  Society  for 
over  nineteen  years  and  is  also 
an  active  member  of  Mesa 
County  Medical  Society. 


Never  in  the  history  of  mankind 
has  the  physician  been  able  to  treat 
sickness  with  such  skill.  The  number 
and  variety  of  tools  at  our  disposal 
are  astounding  and  improving  every 
day.  So,  why  am  I so  glum? 

The  astronomical  rise  in  both  the 
quality  and  quantity  of  health  care  an 
the  unquenchable  demand  for  it  has 
resulted  in  ever-increasing  costs. 
There  are  very  strong  feelings  that  we 
can  no  longer  afford  to  pay  for  it. 

We  are  victims  of  our  own  success. 
We  are  an  army  that  has  marched 
beyond  its  supply  lines. 

All  efforts  to  effectively  control 
costs  have  failed.  The  purchasers  of 
health  care  (insurance  companies 
and  federal  agencies  rather  than 
patients)  have  primarily  focused  on 
physicians'  fees.  Although  they  have 
had  spectacular  success  in  reducing 
these  fees,  they  have  had  minimal 
influence  on  the  overall  costs 

Health  care  delivery  has  drasti- 
cally changed  since  the  1 940s,  as 
have  physicians'  practices.  The 
problem  is  basically  that  these 
changes  have  not  been  in  sync. 

Patients  have  purchased  health 
care  insurance,  and  in  doing  so  have 
abrogated  their  duty  to  be  prudent 
consumers.  We  have  too  willingly 
accepted  this  change  and  have  lost 
our  moral  obligation  to  be  prudent 
providers. 

Professional  fees  are  a very  small 
portion  of  health  care  costs.  I don't 
believe  that  the  fees  can  be  cut  any 
further,  as  this  is  already  having  a 
negative  effect  on  patient  access. 

Physicians  are  the  only  ones  with 
a license  to  practice  medicine.  We 
have  a monopoly.  No  health  care  is 
provided,  and  therefore  no  costs  are 


incurred,  without  our  authorization. 
If  health  care  costs  are  too  high,  then 
let's  lower  them. 

I believe  that  at  least  25%  of  the 
costs  that  I authorize  are  not  prima- 
rily for  the  patient's  best  interest. 

The  reasons  are  many,  excuses 
abound,  and  I have  used  them  all. 

I also  believe  that  I could 
eliminate  half  of  the  inappropriate 
charges  with  minimal  effort.  The 
remainder  might  be  a little  more 
difficult,  but  could  be  achieved  with 
a little  education. 

We  need  to  look  to  the  past  and 
remember  when  we  were  caring 
physicians  and  prudent  caretakers  of 
our  patients'  resources.  We  need  to 
remember  our  role  as  patient  advo- 
cate. We  are  the  only  ones  that  can 
control  health  care  costs.  We  are  in 
the  driver's  seat.  We  have  always 
been  in  the  driver's  seat.  All  we 
have  to  do  is  pick  up  the  reins  and 
get  going. 


450 


Colorado  Medicine  for  December,  1993 


ARAPAHOE  MEDICAL  SOCIETY 


J Timothy  Ammons,  MD 
3600  E Alameda  Ave  #120 
Denver,  CO  80209 
Elected  09/21/93 

William  T Bolthouse,  MD 
850  E Harvard  Ave  #325 
Denver,  CO  80210 
Elected  09/21/93 

Eric  N Britton,  MD 
2535  S Downing  St  #500 
Denver,  CO  80210 
Elected  09/21/93 

Daniel  T Chin,  MD 
799  E Hampden  Ave  #1 00 
Englewood,  CO  801 1 0 
Elected  07/20/93 

Jack  D England,  DO 
825  E Pikes  Peak  Ave 
Colorado  Springs,  CO  80907 
Elected  11/01/93 

Timothy  M Fullagar,  MD 
701  E Hampden  Ave  #560 
Englewood,  CO  801 1 0 
Elected  09/21/93 

Jane  E Mallet,  MD 
950  E Harvard  Ave  #1 00 
Denver,  CO  80210 
Elected  09/22/93 

Lucas  Njo,  MD 
333  N Hampden  Ave  #600 
Englewood,  CO  801 10 
Elected  09/01/93 

Celinde  Y Strohl,  MD 
7750  S Broadway  #100 
Littleton,  CO  801 22 
Elected  09/21/93 

Sarah  B VanScoy,  MD 
206  W County  Ln  Rd  #1 10 
Highlands  Ranch,  CO  801 26 
Elected  09/21/93 


Tambra  R Woods,  MD 
701  E Hampden  Ave  #330 
Englewood,  CO  801 1 0 
Elected  10/19/93 

AURORA-ADAMS  COUNTY 
MEDICAL  SOCIETY 

Alan  P Aboaf,  MD 
14991  E Hampden  Ave  #1  50 
Aurora,  CO  80014 
Elected  08/1  3/93 

Carl  M Adolph,  MD 
1 929  Egbert  St  #K 
Brighton,  CO  80601 
Elected  10/01/93 

Joyce  G Ballard,  MD 
3956  W 103rd  Ave 
Westminster,  CO  80030 
Elected  10/15/93 

Elizabeth  R Benyi,  DO 
1 929  Egbert  St  #B 
Brighton,  CO  80601 
Elected  09/14/93 

Joseph  M Forrester,  MD 
830  Potomac  Cir  #345 
Aurora,  CO  8001 1 
Elected  10/01/93 

David  Q McArdie,  MD 
1 6567  E Berry  Ln 
Aurora,  CO  8001  5 
Elected  09/01/93 

Miguel  A Morales,  MD 
1 1 1 75  E Mississippi  Ave  #210 
Aurora,  CO  8001  2 
Elected  10/01/93 

Denise  Panuccio,  MD 
1421  S Potomac  St  #260 
Aurora,  CO  8001 2 
Elected  10/01/93 

Nelson  A Prager,  MD 
1421  S Potomac  St  #40 
Aurora,  CO  8001  2 
Elected  10/01/93 


Luciano  Sztulman,  MD 
14991  E Hampden  Ave  #200 
Aurora,  CO  80014 
Elected  10/01/93 

Girish  C Vallabhan,  MD 
750  Potomac  St  #1 1 7 
Aurora,  CO  8001 1 
Elected  1 0/1 5/93 

Rose  A Warhank,  MD 
830  Potomac  Cir  #250 
Aurora,  CO  8001 1 
Elected  09/14/93 

BOULDER  COUNTY  MEDICAL 
SOCIETY 

Lynn  F Abrams,  MD 
2525  4th  St  #204 
Boulder,  CO  80304 
Elected  09/20/93 

Pamela  R Abrams,  MD 
90  Health  Park  Dr  #260 
Louisville,  CO  80027 
Elected  08/25/93 

Leigh  O Atkinson,  MD 
St  Anthony's  Hosp  N 
2551  W 84th  Ave 
Westminster,  CO  80030 
Elected  09/01/93 

Francesco  G Beuf,  MD 
2880  Folsom  St  #100 
Boulder,  CO  80304 
Elected  08/25/93 

David  W Britt,  MD 
1925  W Mountain  View  Ave 
Longmont,  CO  80501 
Elected  09/01/93 

Jeffrey  T Clarke,  MD 
90  Health  Park  Dr  #290 
Louisville,  CO  80027 
Elected  09/01/93 

Geoffrey  A Geer,  MD 
485  Grape  Ave 
Boulder,  CO  80304 
Elected  08/25/93 


Colorado  Medicine  for  December,  1993 


451 


DENVER  MEDICAL  SOCIETY 


Helen  L Goldberg,  MD 
1000  Alpine  Ave  #201 
Boulder,  CO  80304 
Elected  08/25/93 

John  D Leonard,  MD 
1925  W Mountain  View  Ave 
Longmont,  CO  80501 
Elected  09/01/93 

I Dugan  Mahoney,  MD 
5659  College  PI 
Boulder,  CO  80303 
Elected  08/25/93 

Stephen  D Paul,  MD 
933  Alpine  Ave 
Boulder,  CO  80304 
Elected  08/25/93 

William  G Stahl  III,  MD 
1925  W Mountain  View  Ave 
Longmont,  CO  80501 
Elected  09/01/93 

CLEAR  CREEK  VALLEY  MEDICAL 
SOCIETY 

Nancy  L Cain,  MD 
8300  Alcott  St  #300 
Westminster,  CO  80030 
Elected  09/30/93 

Vicki  L Coulter,  MD 
1 3772  Denver  W Pkwy 
B-55  #100 
Golden,  CO  80401 
Elected  09/1 4/93 

Darlene  K Mullon,  MD 
3655  Lutheran  Pkwy  W #102  D 
Wheat  Ridge,  CO  80033 
Elected  07/27/93 

Madelyn  S Palmer,  MD 
1 930  S Federal  Blve 
Denver,  CO  80219 
Elected  09/29/93 

CMS  DIRECT  MEMBER  MEDICAL 
SOCIETY 

Linda  Alvarez,  MD 

9057  E Mississippi  Ave  #1  3-1 05 

Denver,  CO  80231 

Elected  09/1  7/93 

Michael  J Champine,  MD 
9123  E Mississippi  Ave  #3-102 
Denver,  CO  80231 
Elected  09/17/93 

Donald  S Corenman,  MD 
9400  E 1 1 iff  Ave  #024 
Denver,  CO  80231 
Elected  09/1  7/93 


Loralie  A Davis,  MD 
12223  W 2nd  PI  #11-307 
Lakewood,  CO  80228 
Elected  09/1  7/93 

Kevin  P Fennelly  MD,  MPH 
1 400  Jackson  St 
Occup/enviro 
Denver,  CO  80206 
Elected  09/1  7/93 

David  D Gerding,  MD 
13210  Mercury  Dr 
Littleton,  CO  801  24 
Elected  09/1  7/93 

Steven  H Hansen,  MD 
3060  Colorado  Blvd 
Denver,  CO  80207 
Elected  09/1  7/93 

Muhammad  F Khan,  MD 
7575  E Arkansas  Ave  #41 08 
Denver,  CO  80231 
Elected  09/17/93 

Michael  A Kohn,  MD 
444  Gilpin  St 
Denver,  CO  80218 
Elected  09/17/93 

Jerome  P Limoge,  MD 
18092  E Lehigh  PI 
Aurora,  CO  8001  3 
Elected  09/17/93 

Donna  L Nimec,  MD 
9208  W 100th  Cir 
Westminster,  CO  80021 
Elected  09/1  7/93 

Thomas  R Parsons,  MD 
10905  W Ohio  Dr 
Lakewood,  CO  80226 
Elected  09/1  7/93 

Robert  A Paul,  DO 
7500  E Quincy  Ave  #F-1 07 
Denver,  CO  80237 
Elected  09/1  7/93 

Kathy  P Raven,  MD 
1 361  Tamarac  St 
Denver,  CO  80220 
Elected  09/1  7/93 

David  M Schrier,  MD 
5908  Southmoor 
Englewood,  CO  801 1 1 
Elected  09/1  7/93 

Mary  A Underwood,  MD 
767  W Orchard  Ave 
Grand  Junction,  CO  81  501 
Elected  09/1  7/93 


Richard  Allen,  MD 
1 835  Franklin  St 
Denver,  CO  80218 
Elected  09/01/93 

G Samuel  Baker,  MD 
777  Bannock  St 
Dept  of  Anes 
Denver,  CO  80204 
Elected  10/01/93 

jon  M Burch,  MD 
777  Bannock  St 
Dept  of  Surgery 
Denver,  CO  80204 
Elected  10/01/93 

Bruce  N Calonge,  MD 
1 0350  E Dakota  Ave 
Denver,  CO  80231 
Elected  10/01/93 

David  A Connett,  DO 
5715  E 63rd  PI 
Commerce  City,  CO  80022 
Elected  10/01/93 

Kim  M Feldhaus,  MD 
515  Clarkson  St  #7 02 
Denver,  CO  80218 
Elected  10/01/93 

Kevin  Fitzpatrick,  MD 
1111  Race  St  #8A 
Denver,  CO  80206 
Elected  10/01/93 

Alan  S Hanson,  MD 
1601  E 19th  Ave  #4300 
Denver,  CO  80218 
Elected  10/01/93 

Jack  H Hufford,  DO 
19103  E 46th  Ave 
Denver,  CO  80219 
Elected  10/01/93 

Daniel  D Lowery,  MD 
6311  E 1 4th  Ave 
Denver,  CO  80220 
Elected  10/01/93 

George  W Manning,  MD 
360  S Garfield  St 
Denver,  CO  80209 
Elected  10/01/93 

Arlene  R Martone,  MD 
41 1 Sherman  St 
Fort  Morgan,  CO  80701 
Elected  10/01/93 

William  P Nelson,  MD 
1 835  Franklin  St 
Denver,  CO  8021  8 
Elected  09/01/93 


452 


Colorado  Medicine  for  December,  1993 


Stuart  G Rosenberg,  MD 
777  Bannock  St 
Denver,  CO  80204 
Elected  10/01/93 

Susan  W Ryan,  DO 
71 6 S Washington  St 
Denver,  CO  80209 
Elected  10/01/93 

Stuart  I Senkfor,  DO 
3333  E Bayaucl  Ave  #803 
Denver,  CO  80209 
Elected  10/01/93 

Richard  L Stieg,  MD 
1210  43rd  Ave 
Greeley,  CO  80634 
Elected  09/01/93 

David  B Stuhldreher,  MD 
2005  Franklin  St  #710 
Denver,  CO  80205 
Elected  10/01/93 

David  M Terry,  MD 
1165  St  Paul  St 
Denver,  CO  80206 
Elected  10/01/93 

Derek  S Watson,  MD 
8300  E Yale  Ave  #5-102 
Denver,  CO  80231 
Elected  10/01/93 

Judith  L Williams,  MD 
4200  W Conejos  PI  #524 
Denver,  CO  80204 
Elected  10/01/93 

Vicky  L Youngman,  DO 
1 1 90  S Clayton  St 
Denver,  CO  80210 
Elected  09/01/93 

EL  PASO  COUNTY  MEDICAL 
SOCIETY 

Stuart  A Blitzer,  MD 
PO  Box  1330 

Colorado  Springs,  CO  80901 
Elected  09/08/93 

Andrew  C Catron,  MD 
3111  Serendipity  Cir 
Colorado  Springs,  CO  8081  7 
Elected  09/08/93 

John  V Cichon  Jr,  MD 
3100  N Academy  Blvd  #21 1 
Colorado  Springs,  CO  80917 
Elected  09/1 5/93 

Faith  M Cowgill,  MD 
1400  E Boulder  St 
Colorado  Springs,  CO  80909 
Elected  09/08/93 


Peter  W Creech,  MD 
620  C Autumn  Crest  Cir 
Colorado  Springs,  CO  80919 
Elected  09/08/93 

Martha  L D'Ambrosio,  MD 
625  N Cascade  Ave  #2 1 0 
Colorado  Springs,  CO  80903 
Elected  09/08/93 

Cheryl  A Ellis,  MD 
19935  Indian  Summer  Ln 
Monument,  CO  801  32 
Elected  09/08/93 

Thomas  P Eyen,  MD 
71  5 N Cascade  Ave 
Colorado  Springs,  CO  80903 
Elected  09/08/93 

Linton  S Holsenbeck  III,  MD 
2989  Broadmoor  Valley  Rd 
Colorado  Springs,  CO  80906 
Elected  09/08/93 

David  A Stark,  MD 
3585  Van  Teylingen  Dr 
Colorado  Springs,  CO  8091  7 
Elected  09/08/93 

Richard  E Stockelman,  MD 
801  N Cascade  Ave 
Colorado  Springs,  CO  80903 
Elected  09/08/93 

Steven  B Waskow,  MD 
209  S Nevada  Ave 
Colorado  Springs,  CO  80903 
Elected  09/08/93 

FREMONT  COUNTY  MEDICAL 
SOCIETY 

Robert  D McCurry,  DO 
832  Macon  Ave 
Canon  City,  CO  81212 
Elected  06/30/93 

INTERMOUNTAIN  MEDICAL 
SOCIETY 

Paul  F DeChant,  MD 
PO  Box  930 
555  S Park  Ave 
Breckenridge,  CO  80424 
Elected  0 

LA  PLATA  COUNTY  MEDICAL 
SOCIETY 

Edward  C Pino,  MD 
1800  E 3rd  Ave  #16 
Durango,  CO  81  301 
Elected  06/30/93 

LARIMER  COUNTY  MEDICAL 
SOCIETY 


Bruce  R Belleville,  MD 
1024  S Lemay  Ave 
Fort  Collins,  CO  80524 
Elected  09/01/93 

Guy  P Van  der  Werf,  MD 
131  Stanley  Ave 
PO  Box  1436 

Estes  Park  CO  80517  586-2343 

MEDICAL  STUDENT  COMPONENT 
MEDICAL  SOCIETY 

Bruce  W Adams 
861 8 E Eastman  Ave 
Denver,  CO  80231 
Elected  09/1  5/93 

Holly  L Amsbury 
1175  Albion  St  #105 
Denver,  CO  80220 
Elected  09/01/93 

Katherine  P Anderson 
1535  Dahlia  St 
Denver,  CO  80220 
Elected  09/1 1/93 

Laura  C Anderson 
5040  S Meade  St 
Littleton,  CO  801 23 
Elected  09/1  5/93 

Jacquelyn  K Aschenbrenner 
1 1 00  1/2  Harrison  St 
Denver,  CO  80206 
Elected  09/01/93 

Philip  L Baese 
975  Harrison  St 
Denver,  CO  80206 
Elected  09/1 5/93 

John  F Barrett 
1 030  Monroe  St 
Denver,  CO  80206 
Elected  09/1  5/93 

Sonya  J Becker 
811  32nd  St 
Denver,  CO  80205 
Elected  09/1  5/93 

Martin  J Bell 

7575  E Arkansas  Ave  #1-203 
Denver,  CO  80231 
Elected  09/1 5/93 

John  A Berneike 
3833  Howe  Ct 
Boulder,  CO  80301 
Elected  08/03/93 

Dave  A Biddle 
1 905  Zinnia  St 
Golden,  CO  80401 
Elected  09/01/93 


Colorado  Medicine  for  December,  1993 


453 


Elizabeth  A Brost 
3535  S Clarkson  St  #406 
Englewood,  CO  801 10 
Elected  08/1 5/93 

Rosario  Floridia  Jr 
880  Dexter  St  #307 
Denver,  CO  80220 
Elected  08/20/93 

Cars  R Loss 
6922  S Trenton  Dr 
Englewood,  CO  801 1 2 
Elected  09/11/93 

Teresa  M Bueche 
1155  Ash  St  #1102 
Denver,  CO  80220 
Elected  09/1  5/93 

Eliza  Y Foo 
860  Clermont  St  #708 
Denver,  CO  80220 
Elected  09/01/93 

Gergory  J Martin 
985  Harrison  St 
Denver,  CO  80206 
Elected  08/20/93 

Holly  T Burggraf 
1 0243  E Peakview  Ave  #1 01 
Englewood,  CO  801 1 1 
Elected  09/29/93 

Daniel  W Fosburgh 
2132  S Victor  St  #C 
Aurora,  CO  8001 4 
Elected  09/01/93 

Michelle  T Mueller 
4801  E 9th  Ave  #705 
Denver,  CO  80220 
Elected  08/03/93 

Stephanie  C Calkins 
8241  S Fillmore  Way 
Littleton,  CO  80122 
Elected  09/1  5/93 

Peter  L Free 
8839  Valmont  Dr 
Boulder,  CO  80301 
Elected  09/1 1/93 

David  A Nowick 
820  Dexter  St  #14 
Denver,  CO  80220 
Elected  09/29/93 

Karin  B Cesario 
880  Cherry  St  #204 
Denver,  CO  80220 
Elected  09/01/93 

Amy  E Ghaibeh 
2225  Buchtel  Blvd  #503 
Denver,  CO  80210 
Elected  09/1 5/93 

Mary  T O'Kief 
878  S Dexter  St  #606 
Denver,  CO  80222 
Elected  08/03/93 

David  A Chavez 
8843  N Colorado  Blvd  #B-305 
Thornton,  CO  80229 
Elected  08/1 5/93 

Robert  E Gramling 
970  Forest  St 
Denver,  CO  80220 
Elected  08/03/93 

John  A Odom  Jr 
3370  S Ivy  Way 
Denver,  CO  80222 
Elected  09/1 5/93 

Brian  L Cruz 
1175  Albion  St  #2 13 
Denver,  CO  80220 
Elected  09/1 5/93 

Douglas  K Hammond 
431 4 S Eagle  Cir 
Aurora,  CO  8001  5 
Elected  08/24/93 

Jason  Persoff 
2838  S Oakland  Cir  E 
Aurora,  CO  80014 
Elected  09/01/93 

Michelle  A Deden 
5412  Quari  St 
Denver,  CO  80239 
Elected  08/20/93 

Shanna  R Harris 
6950  Silverheels  Ct 
Widefield,  CO  8091 1 
Elected  08/1  5/93 

Robert  L Petersen 
955  Harrison  St 
Denver,  CO  80206 
Elected  09/1 5/93 

James  Derrisaw 
10225  E Girard  Ave  #F-203 
Denver,  CO  80231 
Elected  09/1 5/93 

Ray  W Howe 
PO  Box  4186 
Evergreen,  CO  80439 
Elected  09/1 5/93 

Maya  E Pring 
830  Dexter  St  #9 
Denver,  CO  80220 
Elected  08/03/93 

Andrew  S Diamond 
71 2 Spruce  St 
Boulder,  CO  80302 
Elected  08/26/93 

David  Q Hutcheson-Tipton 
2253  S Buckley  Rd  #201 
Aurora,  CO  8001  3 
Elected  09/1  5/93 

Annette  V Riggs 
1230  Ash  St 
Denver,  CO  80220 
Elected  08/20/93 

Nathaniel  L Eastman 
901  Harrison  St 
Denver,  CO  80206 
Elected  09/1 5/93 

Geoffrey  B Kostiner 
3329  E Bayaud  Ave  #1  506 
Denver,  CO  80209 
Elected  09/29/93 

Kristen  B Rundell 
421  Winona  Ct 
Denver,  CO  80204 
Elected  09/01/93 

Phaedra  A Fegley 
3820  E 10th  Ave 
Denver,  CO  80206 
Elected  09/01/93 

Michelle  R Kuntz 
1155  Ash  St  #1102 
Denver,  CO  80220 
Elected  09/1 5/93 

Benjamin  E Schneider 
870  Dexter  St  #108 
Denver,  CO  80220 
Elected  09/11/93 

Sherry  J Ferrell 
3710  W 103rd  Dr 
Westminster,  CO  80030 
Elected  09/1 1/93 

Astrid  S Lampey 
1210  Harrison  St  #29 
Denver,  CO  80206 
Elected  09/1  5/93 

Maria  B Straub 
1925  S Cook  St 
Denver,  CO  80210 
Elected  09/1 5/93 

Lizbeth  K Field 
1175  Albion  St  #1 1 7 
Denver,  CO  80220 
Elected  09/29/93 

Richard  C H Lee 
880  Cherry  St  #401 
Denver,  CO  80220 
Elected  09/11/93 

Duane  E Thomas 
1 1 90  Clermont  St  #3 
Denver,  CO  80220 
Elected  09/1 5/93 

454 


Colorado  Medicine  for  December,  1993 


Michael  C Thompson 
825  S Jersey  St 
Denver,  CO  80224 
Elected  10/18/93 

Andrea  N Towne 
1 404  Hudson  St 
Denver,  CO  80220 
Elected  09/1 5/93 

Xuan-Trang  T Truong 
4672  W Union  Ave 
Denver,  CO  80236 
Elected  08/03/93 


Benton  F Murphy  III,  MD 
27  Montebello 
Pueblo,  CO  81001 
Elected  09/20/93 

Christopher  R Speer,  MD 
1008  Minnequa  Ave 
Pueblo,  CO  81004 
Elected  09/20/93 


Kathleen  Walker 
1118ZW  17th  Ave  #4-307 
Lakewood,  CO  80215 
Elected  08/24/93 

Leslie  L Wilke 
940  Quince  Ave 
Boulder,  CO  80304 
Elected  08/03/93 

MESA  COUNTY  MEDICAL  SOCIETY 

Roland  J Marasco,  MD 
653  26  1/2  Rd 
Grand  junction,  CO  81  506 
Elected  0 

MT.  EVANS  MEDICAL  SOCIETY 

Theodore  R Villavicencio,  MD 
10791  Kitty  Dr  #A 
Conifer,  CO  80433 
Elected  10/01/93 

PUEBLO  COUNTY  MEDICAL 
SOCIETY 

Howard  L Chamberlain,  MD 
1 62  E Hahns  Peak  Ave 
Pueblo  West,  CO  81007 
Elected  09/20/93 

C R FallHowe,  MD 
1008  Minnequa  Ave 
Pueblo,  CO  81004 
Elected  09/20/93 

Takla  E Gardey,  MD 
1 008  Minnequa  Ave 
Pueblo,  CO  81 004 
Elected  09/20/93 

Paul  C Gering  Jr,  MD 
2027  Acero  Ave  #56 
Pueblo,  CO  81004 
Elected  09/20/93 

Matthew  D Lewis,  MD 
1008  Minnequa  Ave 
Pueblo,  CO  81004 
Elected  09/20/93 


Physician  Recognition  Awards 


The  Colorado  Medici  Society  joins  the  American  Medical  Assoxiation  in 
recognizing  the  following  physicians  for  their  dedication  to  excellence  in 
the  profession  of  medicine,  as  demonstrated  in  their  commitment  to 
continuing  medical  education. 


Lee  T.  Baker 
Sally  C.  Berger 
Benjamin  L.  Crue 
Morton  W.  Dann 
William  E.  Emeis 
G.T.  Jim  Foust 
James  J.  Gregory 
Gerald  W.  Griebel 


Glenn  O.  Hewitt 
Marisa  Moritz 
John  D Newell 
Harold  L.  Paul 
John  L.  Smith 
Marc  J.  Sorkin 
Le  Roy  H.  Stahlgren 
Gordon  K.  Tagge 
Celsa  T.  Tiu 


^StRiul 

Medical  Services 

Specialists  in  Medical 
Liability  Insurance 

St.  Paul  Fire  and  Marine  Insurance  Company 

Denver  Service  Center 
12250  E.  IlifF  Avenue,  Suite  400 
Aurora,  Colorado  80044 

303.696.7500 


For  more  information  about  The  St.  Paul’s  medical  professional 
liability  insurance  contact  your  independent  insurance  agent  or  the 
Denver  Service  Center. 


Colorado  Medicine  for  December,  1993 


455 


lassified  Advertising 


Publication  of  any  advertisement  in  Colorado  Medicine  is  not  an  endorsement  by  the  Colorado  Medical  Society 
of  the  product  or  service.  Colorado  Medicine  magazine  is  the  official  journal  of  the  Colorado  Medical  Society,  and 
is  authorized  to  carry  General  Advertising. 


♦ PROFESSIONAL  OPPORTUNITIES 

WHEATRIDGE:  Full  or  part  time  positions 
for  BP/BC  Primary  Care  or  Emergency 
Physicians  in  fasttrackclinic.  Contact  Alex 
Maslanka,  MD.,  Emergency  Service 
Physicians,  8300  West  38th  Ave.  Wheat 
Ridge,  CO.  80033;  (303)  444-7618. 

2/1193 

BOARD  CERTIFIED  (MD.)  GENERAL 
SURGEON  lookingto  relocate  to  Colorado, 
preferably  Denver-Boulderarea.  Available 
soon.  Please  send  inquires  to  Box  R,  C/O 
ColoradoMedical  Society,  P.O.  Box  1 7550, 
Denver,  CO  80217-0550.  1/1193 

An  excellent  practice  opportunity  exists 
for  a BC/BE  Family  Practice  physician  to 
assume  the  practice  of  retiring  physician  in 
northern  Colorado.  The  successful  can- 
didate will  have  immediate  access  to  an 
established  patient  base,  and  will  affiliate 
with  7 physician  Family  Practice  group  for 
call  coverage.  This  is  a solo  practice  in 
LaSalle,  Colorado,  approximately  50  miles 
north  of  Denver  and  an  hour  from  the 
mountains.  An  excellent  school  system, 
modestly  priced  housing,  a four  year 
University  and  community  college  are  all 
available  locally.  Supporting  hospital  is 
286  bed  regional  medical  center  with 
Family  Practice  residency  program. 
Competitive  compensation  and  benefits. 
Send  CV to:  Vicki  Baier,  Director,  Physician 
Support,  North  Colorado  Medical  Center, 
1 801  1 6th  Street,  Greeley,  CO.  80631 . 

2/1  293 

LOCUM  TENENS...  new  adventures,  free 
from  administrative  tasks,  flexibility,  and 
high  earnings.  Assignments  vary:  one  day, 
one  week,  one  month,  long  term,  OR,  time 
off  with  peace  of  mind,  knowing  that  your 
practice  goes  uninterrupted.  Qualified 
physicians  are  ready  to  assist.  Ten  years 
experience;  physician-managed  company. 
Call  INTERIM  PHYSICIANS  today  for 
details. — Denver  69 1-071 8,  or  1 -800-669- 
0718  12/1292 


OB/GYN  PHYSICIAN  — Full  or  part-time 
position  in  Tri-County  Health  Department's 
Women's  Health  Clinics.  Duties  include 
direct  care  to  ambulatory  obstetric  and 
family  planning  patients,  colposcopy,  LEEP, 
cryotherapy,  Norplant®  insertion,  medical 
supervision  of  nurse  practitioner  staff  and 
co-signing  encounters.  Must  be  Board 
Certified/Eligible  in  OB/GYN  and  have  or 
be  eligible  for  Colorado  medical  license. 
Clinics  operate  Mon-Fri  8am  to  5pm, 
occasional  evenings.  No  weekend  or  after 
hours  call.  Competitive  salary  and  benefits. 
Malpractice  protection  through  Govern- 
mental Immunity.  Job-sharing  arrangement 
considered.  Send  resume  to:  Dr.  Hugh 
Rohrer,  Tri-County  Health  Department, 
7000  E Belleview,  Suite  301,  Englewood 
CO  801 1 1-1628.  1/1293 


PRACTICE  OPPORTUNITY-  Excellent 
opportunity  for  a Board  Certified  or 
eligible  Family  Practitioner  to  join  a 30 
physician,  well  established  multi- 
specialty group.  LongmontClinic  will  be 
expanding  their  services  to  include  a 
satellite  office  in  a nearby  community. 
Longmont,  Colorado  is  located  45  miles 
north  of  Denver  in  the  beautiful  front 
range  of  the  Rockies.  Longmont  Clinic 
offers  a competitive  salary  with  an 
incentive  program.  Excellent  corporate 
fringe  benefit  program.  For  more 
information  please  contact:  Admin- 
istration, Longmont  Clinic,  P.C.,  1925 
W.  Mountain  View  Avenue,  Longmont, 
CO.  80501,  (303)  776-1234  (Collect). 
2/1 1 93 


TIRED  OF  THE  DAY  TO  DAY  HASSLE  of 

HMO's,  Medicare,  discounted  insurance 
and  being  on  cal  I?  Then  consider  a position 
with  corrections.  Before  you  say  "No  Way," 
call  us  and  find  out  more.  Contact  Roderic 
Gottula,  MD,  10900  Smith  Road,  Denver, 
CO  80239  or  call  (303)  375-21 1 0.6/0793 


FAMILY/GENERAL  PRACTICE  PHYS- 
ICIANS - Northwest  Kansas  community, 
Atwood,  Kansas  offers  many  opportunities 
to  raise  a family  in  a healthy  lifestyle,  and 
stable,  yet  economically  sound  environ- 
ment. Excel  lent  cl  i n ic  faci  I ities,  outstanding 
benefits  and  call  schedule.  Call  Jeffrey 
Bensman  at  1 -800-638-6942.  3/1 1 93 

BC/BS  FAMILY  PRACTICE  to  staff  minor 
care  clinic  in  Emergency  Room.  Full  or  part 
time  - currently  staffing  weekends.  6 or  1 2 
hour  shifts  available  immediately.  Send  CV 
or  call:  Tom  Harms,  MD..,  North  Colorado 
Medical  Center,  1 801  1 6th  Street,  Greeley, 
CO.  80631,  (303)  350-6244.  2/1193 

♦ EQUIPMENT  FOR  SALE  OR  LEASE 

X-RAY  MACHINE  and  accessories  for  sale. 
300  mA,  tilt  table,  BUCKEY;  HAND  TANKS, 
film,  cassettes,  Lead  apron,  View  boxes, 
etc.  Contact  Dr.  BARBARA  PHILLIPS  (303) 
449-3504.  1/1293 

FOR  SALE— BRAND  NEW  EKG  Machine 
— Never  used.  Hewlett  Packard  Pagewriter 
11-12  lead,  single  sheet.  Asking  $2,500  or 
best  offer.  Paid  $3,000  New.  Call  Dr. 
Tannenbaum  at  (303)  776-7300.  3/1293 

DUE  TO  INCREASED  CLIA  REGULA- 
TIONS, Moffat  Family  Clinic  is  offering  the 
following  equipment  for  purchase.  Abbott 
Vision  Machine,  IMEX  Lab  9000  Peripheral 
Vascu  lar  System  and  QBC  Reference  System 
Hematology  Analyzer.  For  information 
please  contact  Moffat  Family  Clinic,  600 
Russell,  Craig,  CO  81  625  or  call  (303)  824- 
3252.  contact  person  - Judy  Milner,  office 
manager  or  Larry  Kipe,  MD.  3/1 093 

BUY  DIRECT— LOCAL  MFG..  Custom 
Office  Furniture — Desks,  Credenzas, 
bookcases,  Files,  work  stations,  waiting 
room  seating,  etc.  Oak-cherry  & walnut. 
We  build  quality  custom  office  furniture  at 
a price  you  can  afford.  Mark  IV  Systems, 
Inc.  297-1  248.  8:00-4:30  M-F.  1 2/0293 


456 


Colorado  Medicine  for  December,  1993 


Classified 


♦ SITUATIONS  WANTED 

CPA  Seeks  20  hours/week  in  a doctor's 
office,  performing  all  aspects  of  office 
administration,  including  financial  state- 
ment preparation,  insurance  administration 
and  bookkeeping.  Is  also  interested  in 
volunteering  4 hours  a week  "on  the  floor". 
Would  prefer  one-  or  two-doctor  Ob/Gyn 
or  Family  Practice  with  annual  revenues  of 
$1,000,000.  Please  call  987-2977.1/1 293 

♦ SERVICES 

DOCTORS/DENTISTS/OFFICE  MGRS.,  Is 

your  accounts  receivable  mounting  due  to 
unpaid/rejected  claims?  Are  you  having 
problems  keeping  your  CPT  and  Diagnosis 
codes  up-to-date?  Let  us  show  you  how  we 
can  help  you  and  help  reduce  your 
administrative  cost.  Call  (303)  840-0998  or 
1 -800-MEDIPAY 
1-800-633-4729 

2/1 1 93 

QUICK  CLAIM  ELECTRONIC  CLAIMS 
PROCESSORS,  HMO  PPO,  MEDICARE, 
MEDICAID  AND  PATIENTS  BILLING  (303) 
333-8666.  22/0393 

HOME  MORTGAGE  LOANS 
LOW  DOC  PROGRAM  available  for 
physicians  and  other  health  professionals. 
Purchase  and  refinance.  Call  Milt,  a 
mortgage  banker  with  1 8 years  experience. 
753-6262.  12/1292 

YOUR  PC  PAYS—  YOU  BENEFIT-Tax 

deductible  to  your  personal  corporation. 
Tax  free  distribution  to  you.  $50,000  to 
$100,000  every  year  for  life  provides  a 
method  for  transferring  assets  from  your  PC 
to  you  tax  free!  Call  H.A.  Kline  (303)  850- 
9775.  tfn 

INNOVATIONS  SHOULD  BE  PATENTED 

if  marketable.  For  more  information  call 
Brian  D.  Smith  of  Fields,  Lewis,  Pittenger  & 
Rost.  Colo's  leading  patent  law  firm.  Mr. 
Smith  specializes  in  the  medical  arts.  (303) 
758-8400.  12/1192 


IN  NEED  OF  MEDICAL  - LEGAL  REPRE- 
SENTATION? The  Law  Offices  of  Heckman 
& O'Connor  in  conjunction  with  the  Law 
Offices  of  Grieff  and  Ritchie  are  available 
for  consultation  in  medical  board  disci- 
plinary actions,  hospital  privileges  matters 
and  business  matters.  Phone:  800-488-5 1 1 2 
or  fax:  303-476-9558  or  206-467-6738. 
6/1 1 93 

RESIDENTIAL  REAL  ESTATE  SALES.  Dealing 
in  homes  valued  above  $250,000.  12  yrs. 
exper.  BS:  Real  Estate  and  Construction 
Mgmt-D.U.  MS:  Finance  & Tax  - C.U. 
Steven  Carter,  Pres.  Flatiron  RE  Serv. 
Denver/Boulder  (303)888-0521  12/0893 


AT  LAST!  Colorado  finally  has  a South- 
western owned  and  operated  Physician 
Recruiting  company  that  understands  and 
specializes  only  in  the  Southwest.  Our 
proven  policy  of  friendly,  efficient,  but 
affordable  service  is  now  available  to 
meet  your  Permanent  and  Temporary 
Physician  and  Physician  Assistant  needs. 
We'll  visit  your  clinic,  review  your 
requirements  and  search  for  just  the  right 
person.  All  at  no  cost  to  you!  You  don't 
pay  ifwedon'tsucceed.  Call  us  today!  1 - 
800-657-0354  or  (602)  433-9547,  FAX: 
(602)433-9548.  2/1193 


Your  next  job 
is  on  the  line. 

1-800 *233 '9330 

Finally  you  have  direct  access  to  career  opportunities  across  the 
country.  The  new  Practice  Opportunity  Line  offers  an  easy, 
no  pressure,  confidential  way  to  conduct  a thorough  job  search 
on  your  own,  24  hours  a day.  All  you  have  to  do  is  call,  follow 
the  prompts  and  research  the  openings.  Then  send  a voice  mail 
mini-CV  to  the  opportunities  you  wish  to  pursue.  It’s  die  newest, 
fastest  and  simplest  way  to  get  the  job  you  want. 

The  Practice 
Opportunity  Line 

Were  on  call  for  you. 
from  Physician’s  Market  Information  Center  1 * 800  * 423  * 1 229 


Colorado  Medicine  for  December,  1993 


457 


I 


Ruminations 


(def:  chewing  again  what  has  been  chewed 


slightly  and  swallowed;  to  REFLECT) 


by  Bill  Pierson , Managing  Editor 


My  friend,  the  doctor: 

That's  what  doctoring 
ought  to  be.  It  ought  to  be 
a relationship  between 
the  patient  and  physician 
that  can  last  for  years , 
built  on  a mutual  respect 
and  trust. . . and  com- 
pletely by  choice , both  of 
the  patient  and  the  doctor. 


One  of  the  greatest  comforts  I 
have  had  in  my  lifetime  is 
that  I had  a personal 
physician,  and  when  I didn't  feel 
well  that  physician  could  generally 
set  me  straight.  If  he  couldn't,  he 
knew  of  another  physician,  probably 
a specialist,  who  could. 

Funny,  my  patient-doctor 
relationship  was  one  that  made  me 
feel  better  just  for  seeing  him  and 
talking  with  him.  He  might  not  even 
prescribe  anything. 


Oh,  I admit,  I haven't  had  any 
real  serious  problems  with  my 
health.  A lot  of  that  was  because  I 
was  a good  patient:  I listened  to  the 
doctor  and  tried  to  follow  his  advice 
so  that  when  he  did  see  me  he  knew 
most  everything  about  me.  We 
worked  together  to  develop  that 
relationship.  I felt  a "friendship" 
(because  that's  what  it  developed 
into)  that  has  lasted  for  over  38 
years. 

I like  the  fact  that  my  doctor  has 
been  a good  and  loyal  personal 
friend.  I have  confided  in  him  many 
of  my  deepest  personal  secrets  over 
the  years,  and  he  has  held  that 
confidence  and  advised  me  in  a 
manner  typical  of  a good  friend. 
When  I needed  advice  or  "shoreing 
up"  I could  depend  on  him  to  give 
me  the  time  and  his  wonderful, 
warm,  witty  but  caring  view  of 
things.  Without  pulling  my  leg,  lying 
to  me  or  crying  on  my  shoulder 
about  his  own  problems,  he  sets  out 
to  make  me  feel  better,  and  he 
succeeds. 

That's  what  doctoring  ought  to 

be,  as  far  as  I'm  concerned. 

I've  always  wanted  to  be  of 
some  help  to  my  doctor  but  seldom 
have  the  opportunity.  He's  never  in  a 
position  like  me.  He  has  had  to  be 
the  patient  from  time  to  time,  too, 
but  he  goes  to  see  a doctor  friend  of 
his  own. 

We  are  both  at  some  disadvan- 
tage, because  one  of  us  is  bound  to 
quit  one  of  these  days,  and  then 
where  will  we  be?  But  that's  all  right 
because  I have  had  more  than  half 
my  life  in  this  man's  hands,  and  they 
have  been  great  years  I have  had  as  a 
patient  and  a friend,  so  I wouldn't 


trade  that.  He  tells  me  how  wonder- 
ful these  four  decades  of  his  life  have 
been,  treating  and  serving,  guiding 
and  teaching. 

I'm  not  so  concerned  about  me, 
but  what  about  all  the  other  patients 
who  are  coming  along  and  will  need 
a good  doctor  friend?  Will  they  find 
that  in  the  "doctoring  by  the  num- 
bers" format  that  is  growing  out  of 
"managed  care"  and  "health  care 
reform?"  I think  not. 

The  health  maintenance  organi- 
zation (HMO)  was  the  big  threat  to 
choice  for  so  many  years.  Through 
all  that,  1)  somehow,  I managed  to 
continue  to  see  the  doctor  of  my 
choice;  2)  somehow,  between  the 
two  of  us,  he  managed  to  keep  me 
pretty  well  or  cure  me  when  the 
need  arose.  But  during  all  those 
years  my  doctor  had  to  continue  to 
see  more  people  in  any  given  day 
because  volume  was  the  only  thing 
that  could  keep  his  overhead  paid, 
while  he  refused  to  raise  his  fees  very 
much.  I understood.  I and  the  many 
other  patients  who  filled  his  waiting 
room  waited  patiently  because  we 
were  waiting  to  see  the  doctor  of  our 
choice.  It  wasn't  just  in  my  doctor's 
office.  It  happens  throughout  this 
great  health  care  system  of  ours 
every  day. 

That's  what  doctoring  ought  to 

be.  It  ought  to  be  a relationship 
between  the  patient  and  physician 
that  can  last  for  years,  built  on  a 
mutual  respect  and  trust...  and 
completely  by  choice,  both  of  the 
patient  and  the  doctor. 

I am  so  fortunate  to  have  seen 
and  benefitted  from  the  very  best 
years  of  medicine  through  "my 
friend,  the  doctor". 


458 


Colorado  Medicine  for  December,  1993
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